Provider Demographics
NPI:1598778193
Name:MACPHERSON, LORI G (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:G
Last Name:MACPHERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:G
Other - Last Name:MOSELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1602A N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1010
Practice Address - Country:US
Practice Address - Phone:417-269-2350
Practice Address - Fax:417-269-5626
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205835101Medicaid
157440OtherBLUE CROSS MO
H13477Medicare UPIN
001013668Medicare PIN
157440OtherBLUE CROSS MO