Provider Demographics
NPI:1417098427
Name:WETTER, LOWELL ALBERT (MD)
Entity type:Individual
Prefix:
First Name:LOWELL
Middle Name:ALBERT
Last Name:WETTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALBERT
Other - Middle Name:
Other - Last Name:WETTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:665 BROMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1067
Mailing Address - Country:US
Mailing Address - Phone:650-343-5400
Mailing Address - Fax:
Practice Address - Street 1:665 BROMFIELD RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1067
Practice Address - Country:US
Practice Address - Phone:650-343-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51501208600000X, 246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51501OtherLICENSE
CAYYY34803YMedicaid
CAYYY34803YMedicaid
CAZZZ18792ZMedicare ID - Type Unspecified