Provider Demographics
NPI:1285668475
Name:YEOHAM, LORAINE NADINE (DO)
Entity Type:Individual
Prefix:
First Name:LORAINE
Middle Name:NADINE
Last Name:YEOHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 OAKBEND TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3916
Mailing Address - Country:US
Mailing Address - Phone:817-529-9100
Mailing Address - Fax:817-529-9106
Practice Address - Street 1:5801 OAKBEND TRL STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3916
Practice Address - Country:US
Practice Address - Phone:817-529-9100
Practice Address - Fax:817-529-9106
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126575306Medicaid
TX126575307Medicaid
TX126575308Medicaid
TX126575309Medicaid
TXTXB122058Medicare PIN
TXTXB122078Medicare PIN
TX126575309Medicaid
TX126575306Medicaid
TXTXB122079Medicare PIN