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Individual
DR. JEFFERSON ROY LOWRY
Active
Individual
DR. JEFFERSON ROY LOWRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
F0567
TX
207Y00000X
Otolaryngology Physician
Primary
F0567
TX
207YP0228X
Pediatric Otolaryngology Physician
F0567
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000074EP
BLUE CROSS BLUE SHIELD ID
TX
05
—
0310740-01
—
TX
01
—
2940798
AETNA PROVIDER #
TX
01
—
760330807
TAX ID
TX
01
—
PR29609650002
CIGNA VENDOR NUMBER
TX
Enumeration date
02/10/2006
Last updated
04/09/2014
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