Provider Demographics
NPI:1013009257
Name:LORENZO R PELLY MD
Entity Type:Organization
Organization Name:LORENZO R PELLY MD
Other - Org Name:VALLEY DOCTORS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:R
Authorized Official - Last Name:PELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-544-0755
Mailing Address - Street 1:PO BOX 3190
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-3190
Mailing Address - Country:US
Mailing Address - Phone:956-544-0755
Mailing Address - Fax:956-544-6657
Practice Address - Street 1:864 CENTRAL BLVD
Practice Address - Street 2:SUITE 2500
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7551
Practice Address - Country:US
Practice Address - Phone:956-544-0755
Practice Address - Fax:956-544-6657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN2031OtherRAILROAD MEDICARE
CN2031OtherRAILROAD MEDICARE