Provider Demographics
NPI:1992892459
Name:ALLRED, LOWELL C (MD)
Entity type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:C
Last Name:ALLRED
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 1:508 W DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1887
Mailing Address - Country:US
Mailing Address - Phone:509-754-3563
Mailing Address - Fax:509-754-5124
Practice Address - Street 1:508 W DIVISION AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1887
Practice Address - Country:US
Practice Address - Phone:509-754-3563
Practice Address - Fax:509-754-5124
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8457400Medicaid
WA000304441Medicare ID - Type Unspecified
WAE53856Medicare UPIN