Provider Demographics
NPI:1669649000
Name:LEMLO MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LEMLO MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON-DOZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-364-8107
Mailing Address - Street 1:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71058-0915
Mailing Address - Country:US
Mailing Address - Phone:318-364-8107
Mailing Address - Fax:318-364-8597
Practice Address - Street 1:2533 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 106
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3158
Practice Address - Country:US
Practice Address - Phone:318-364-8107
Practice Address - Fax:318-364-8597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty