Provider Demographics
NPI:1942427810
Name:LENZ, CARA BROOKE (M D)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:BROOKE
Last Name:LENZ
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 DAUPHIN ST
Mailing Address - Street 2:BLDG. 2, SUITE 3 B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1771
Mailing Address - Country:US
Mailing Address - Phone:251-344-5900
Mailing Address - Fax:251-344-5172
Practice Address - Street 1:3715 DAUPHIN ST
Practice Address - Street 2:BLDG. 2, SUITE 3 B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1771
Practice Address - Country:US
Practice Address - Phone:251-344-5900
Practice Address - Fax:251-344-5172
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL129348Medicaid
AL102I161642OtherMEDICARE PTAN