Provider Demographics
NPI:1598871154
Name:ZINK, LORI (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ZINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3941
Mailing Address - Country:US
Mailing Address - Phone:575-746-8880
Mailing Address - Fax:575-622-6645
Practice Address - Street 1:608 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1402
Practice Address - Country:US
Practice Address - Phone:575-746-8880
Practice Address - Fax:575-622-6645
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0597208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27854795Medicaid
NM00NM009K74OtherBCBS
NM27854795Medicaid