Provider Demographics
NPI:1730208497
Name:LOWE, CHAD C (DO)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:C
Last Name:LOWE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30484
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97294-3484
Mailing Address - Country:US
Mailing Address - Phone:702-453-3799
Mailing Address - Fax:702-453-5741
Practice Address - Street 1:1220 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-1831
Practice Address - Country:US
Practice Address - Phone:888-530-4415
Practice Address - Fax:844-578-5605
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO158961207Q00000X
MP479207Q00000X
NY330554-01207Q00000X
WAOP60835057207Q00000X
NJ25IB12188300207Q00000X
CA20A20803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43547200Medicaid
IAENROLLEDMedicaid
OR500650903Medicaid
MN337438100Medicaid
MN080016006Medicare PIN
WI43547200Medicaid
ORR173799Medicare PIN