Provider Demographics
NPI:1235137357
Name:STETLER, LORI D (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:D
Last Name:STETLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8201 PRESTON RD
Mailing Address - Street 2:STE 350
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6203
Mailing Address - Country:US
Mailing Address - Phone:214-631-7546
Mailing Address - Fax:214-631-8546
Practice Address - Street 1:8201 PRESTON RD
Practice Address - Street 2:STE 350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6203
Practice Address - Country:US
Practice Address - Phone:214-631-7546
Practice Address - Fax:214-631-8546
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8436207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE66402Medicare UPIN
TX00074RMedicare ID - Type UnspecifiedGROUP NUMBER