Provider Demographics
NPI:1972527661
Name:LOWERY, CLINTON R (DPM)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:R
Last Name:LOWERY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8370
Mailing Address - Country:US
Mailing Address - Phone:724-935-5533
Mailing Address - Fax:724-935-5890
Practice Address - Street 1:10900 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8370
Practice Address - Country:US
Practice Address - Phone:724-935-5533
Practice Address - Fax:724-935-5890
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002876-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29884Medicare UPIN
PA419338Medicare ID - Type Unspecified