Provider Demographics
NPI:1043214653
Name:CABE, LORENZO C (MD)
Entity Type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:C
Last Name:CABE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-0326
Mailing Address - Country:US
Mailing Address - Phone:662-429-9111
Mailing Address - Fax:662-429-6111
Practice Address - Street 1:900 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2433
Practice Address - Country:US
Practice Address - Phone:662-429-9111
Practice Address - Fax:662-429-6111
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06105355Medicaid
MS110264483Medicare ID - Type Unspecified
MS06105355Medicaid