Provider Demographics
NPI:1275568875
Name:BEIREIS, LORI ANN (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:BEIREIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:MEHRL BEIREIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:500 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2689
Mailing Address - Country:US
Mailing Address - Phone:319-339-0300
Mailing Address - Fax:319-339-3788
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-706-6892
Practice Address - Fax:541-706-6813
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-03737208M00000X
IA3737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0745539Medicaid
IA30937OtherBLUE CROSS BLUE SHIELD
IAI66399Medicare UPIN
IAI18810Medicare ID - Type Unspecified