Provider Demographics
NPI:1619063591
Name:VIDRINE-PARKS, LORI ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ELIZABETH
Last Name:VIDRINE-PARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 RED OAK RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-1984
Mailing Address - Country:US
Mailing Address - Phone:337-506-2060
Mailing Address - Fax:337-506-2060
Practice Address - Street 1:312 COURT ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5248
Practice Address - Country:US
Practice Address - Phone:337-363-5525
Practice Address - Fax:337-363-1567
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.018995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1397539Medicaid
LA372390YYKDMedicare PIN
LAE22880Medicare UPIN