Provider Demographics
NPI:1538119110
Name:MAY-MALONE, LORI JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:JAN
Last Name:MAY-MALONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:JAN
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 MIRON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7862
Mailing Address - Country:US
Mailing Address - Phone:817-749-2000
Mailing Address - Fax:817-749-2020
Practice Address - Street 1:2817 S MAYHILL RD
Practice Address - Street 2:STE 270
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-5966
Practice Address - Country:US
Practice Address - Phone:940-483-9500
Practice Address - Fax:940-483-9550
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL61072085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176245201Medicaid
TX176245201Medicaid
TXI40068Medicare UPIN