Provider Demographics
NPI:1679693808
Name:LORENTSEN, PAUL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:LORENTSEN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1929 W FILLMORE ST, BLDG C
Mailing Address - Street 2:THE NEIGHBORHOOD CHRISTIAN CLINIC
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009
Mailing Address - Country:US
Mailing Address - Phone:602-258-6008
Mailing Address - Fax:602-258-8388
Practice Address - Street 1:1929 W. FILLMORE ST, BLDG C
Practice Address - Street 2:THE NEIGHBORHOOD CHRISTIAN CLINIC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009
Practice Address - Country:US
Practice Address - Phone:602-258-6008
Practice Address - Fax:602-258-8388
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ21354207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ404848OtherAHCCCS