Provider Demographics
NPI:1083730873
Name:PALAZZO, LORI L (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:PALAZZO
Suffix:
Gender:F
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 449
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:512-869-4978
Practice Address - Street 1:10 SPRING ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-4207
Practice Address - Country:US
Practice Address - Phone:512-863-3343
Practice Address - Fax:512-869-4978
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6735Medicare PIN