Provider Demographics
NPI:1992797641
Name:LOWRY, RONALD E (MD, DDS, PA)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:LOWRY
Suffix:
Gender:M
Credentials:MD, DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N CURTIS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1337
Mailing Address - Country:US
Mailing Address - Phone:208-323-1235
Mailing Address - Fax:208-323-1236
Practice Address - Street 1:1000 N CURTIS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1337
Practice Address - Country:US
Practice Address - Phone:208-323-1235
Practice Address - Fax:208-323-1236
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD1753OS1223S0112X
IDM4194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT78458Medicare UPIN
ID1129538Medicare ID - Type Unspecified