Provider Demographics
NPI:1184865974
Name:FOULK, LORA J
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:J
Last Name:FOULK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HOMEFIELD GARDENS CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4478
Mailing Address - Country:US
Mailing Address - Phone:636-441-0906
Mailing Address - Fax:636-928-9288
Practice Address - Street 1:5401 VETERANS MEMORIAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1681
Practice Address - Country:US
Practice Address - Phone:636-441-0906
Practice Address - Fax:636-928-9288
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist