Provider Demographics
NPI:1376675876
Name:FAILES, LORI ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELIZABETH
Last Name:FAILES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ELIZABETH
Other - Last Name:NICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8960 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-7323
Mailing Address - Country:US
Mailing Address - Phone:806-354-1000
Mailing Address - Fax:806-351-6950
Practice Address - Street 1:8960 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-7323
Practice Address - Country:US
Practice Address - Phone:806-354-1000
Practice Address - Fax:806-351-6950
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3667207P00000X
KS0533758207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200619370BMedicaid
KS200619370BMedicaid