Provider Demographics
NPI:1588689996
Name:THOMPSON, LOWERY LEE (MD)
Entity type:Individual
Prefix:MR
First Name:LOWERY
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5327
Mailing Address - Country:US
Mailing Address - Phone:318-329-3481
Mailing Address - Fax:318-330-7080
Practice Address - Street 1:503 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5327
Practice Address - Country:US
Practice Address - Phone:318-329-3481
Practice Address - Fax:318-330-7080
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06816R2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1352349Medicaid
LA50417BC10Medicare PIN
B62379Medicare UPIN