Provider Demographics
NPI:1902880818
Name:LOWTHER, DAVID N (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:LOWTHER
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 1:2234 COLONIAL BLVD.
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1316 NELSON AVE
Practice Address - Street 2:CONTRACTING AND CREDENTIALING DEPT
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5341
Practice Address - Country:US
Practice Address - Phone:209-575-5870
Practice Address - Fax:209-575-5872
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA790892085R0001X, 2085R0001X
NJMA087735002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7971759OtherAETNA
CAP01703383OtherRR MEDICARE
CA1902880818Medicaid
CA00A790890Medicaid
CA7971759OtherAETNA
CA00A790890Medicaid
CACA207964Medicare PIN
GA92BBGBROtherMEDICARE PROVIDER ID
GA527943685EMedicaid
GA527943685GMedicaid
CA00A790890OtherBLUE SHIELD
GA527943685FMedicaid
GA527943685HMedicaid