Provider Demographics
NPI:1992238943
Name:LOWRY, ANDREW (DPM)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LOWRY
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 1:3597 E MONARCH SKY LANE
Mailing Address - Street 2:SUITE 240 PMB 2358
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1055
Mailing Address - Country:US
Mailing Address - Phone:208-996-3519
Mailing Address - Fax:
Practice Address - Street 1:3597 E MONARCH SKY LANE
Practice Address - Street 2:SUITE 240 PMB 2358
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1055
Practice Address - Country:US
Practice Address - Phone:208-996-3519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12611167-0501213E00000X
ORDP209154213E00000X
OK363213E00000X
390200000X
IDP256213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program