Provider Demographics
NPI:1174649784
Name:LORENZ, MARK B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:LORENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3730 RHONE CIR STE 203
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5054
Mailing Address - Country:US
Mailing Address - Phone:907-563-3515
Mailing Address - Fax:907-563-3541
Practice Address - Street 1:3730 RHONE CIR STE 203
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5054
Practice Address - Country:US
Practice Address - Phone:907-563-3515
Practice Address - Fax:907-563-3541
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2023-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK7379207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1577654Medicaid
AK1577654Medicaid