Provider Demographics
NPI:1407975766
Name:COFFEY LORENZO AND ASSOCIATEES
Entity Type:Organization
Organization Name:COFFEY LORENZO AND ASSOCIATEES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DORSEY
Authorized Official - Middle Name:SHANTEL
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:512-771-8731
Mailing Address - Street 1:7200 FLYNN CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-3053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7200 FLYNN CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-3053
Practice Address - Country:US
Practice Address - Phone:512-771-8769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00060247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00060OtherSTATE LIC