Provider Demographics
NPI:1376512277
Name:BROSCH, LORIE C (MD)
Entity Type:Individual
Prefix:DR
First Name:LORIE
Middle Name:C
Last Name:BROSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10027 MAGNOLIA RIV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4277
Mailing Address - Country:US
Mailing Address - Phone:602-708-3665
Mailing Address - Fax:210-292-2962
Practice Address - Street 1:1515 TRUEMPER ST
Practice Address - Street 2:
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-5583
Practice Address - Country:US
Practice Address - Phone:210-292-5205
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24205207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine