Provider Demographics
NPI:1467506709
Name:LOWREY, RANDALL LEROY (PSYD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LEROY
Last Name:LOWREY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:RANDALL
Other - Middle Name:L
Other - Last Name:LOWREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 830981
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34483-0981
Mailing Address - Country:US
Mailing Address - Phone:352-687-0322
Mailing Address - Fax:352-237-8363
Practice Address - Street 1:2609 SW 33RD ST
Practice Address - Street 2:STE 103
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7775
Practice Address - Country:US
Practice Address - Phone:352-687-0322
Practice Address - Fax:352-237-8363
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5806103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54376Medicare ID - Type Unspecified