Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2013044288 | MO |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 2013044288 | MO |
NPI | 1619941879 |
---|---|
Provider Name | Dr. Jerry Lane Lowder |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63108-1495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200011086 | (05) | MO |