Provider Demographics
NPI:1023572500
Name:LOR, TOU
Entity Type:Individual
Prefix:
First Name:TOU
Middle Name:
Last Name:LOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5115 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-7922
Mailing Address - Country:US
Mailing Address - Phone:715-308-9851
Mailing Address - Fax:
Practice Address - Street 1:N5115 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-7922
Practice Address - Country:US
Practice Address - Phone:715-308-9851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor