Provider Demographics
NPI:1790710119
Name:LO, LAURENCE F (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:F
Last Name:LO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4943
Mailing Address - Country:US
Mailing Address - Phone:479-709-7350
Mailing Address - Fax:479-709-7355
Practice Address - Street 1:923 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4943
Practice Address - Country:US
Practice Address - Phone:479-709-7350
Practice Address - Fax:479-709-7355
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5339208600000X
KS04-34106208600000X
ARE7308208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133034209Medicaid
TX133034208Medicaid
AR191979001Medicaid
OK200591720AMedicaid
TXE20500Medicare UPIN
AR191979001Medicaid