Basic Information
| Provider Information | |||||||||
| NPI: | 1538199971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOWELL | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 N GRAND AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | NOGALES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856211061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207612133 | ||||||||
| FaxNumber: | 5202811112 | ||||||||
| Practice Location | |||||||||
| Address1: | 2239 E FRONTAGE RD | ||||||||
| Address2: | |||||||||
| City: | TUBAC | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202811550 | ||||||||
| FaxNumber: | 5202811112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 19871 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | 19871 | AZ | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 207Q00000X | 19871 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 048331 | 01 | AZ | AHCCCS | OTHER |