Provider Demographics
NPI:1942200456
Name:HANES, LORI LEE (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEE
Last Name:HANES
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 1:4206 CALL FIELD RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2519
Mailing Address - Country:US
Mailing Address - Phone:940-397-5200
Mailing Address - Fax:940-367-5287
Practice Address - Street 1:4206 CALL FIELD RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2519
Practice Address - Country:US
Practice Address - Phone:940-397-5200
Practice Address - Fax:940-367-5287
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80671GMedicare ID - Type Unspecified
F73275Medicare UPIN