Provider Demographics
NPI:1437349081
Name:BURREY, LORI PATRICE (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:PATRICE
Last Name:BURREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:PATRICE
Other - Last Name:SMITH-BURREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2170 E BIDWELL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6466
Mailing Address - Country:US
Mailing Address - Phone:916-983-8696
Mailing Address - Fax:
Practice Address - Street 1:2170 E BIDWELL ST STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6466
Practice Address - Country:US
Practice Address - Phone:916-983-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9894208000000X
MN50613208000000X
CAA105155208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics