Provider Demographics
NPI:1962487934
Name:FLECK, LORIE G (MD)
Entity Type:Individual
Prefix:DR
First Name:LORIE
Middle Name:G
Last Name:FLECK
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 1:3719 DAUPHIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1753
Mailing Address - Country:US
Mailing Address - Phone:251-343-9090
Mailing Address - Fax:251-380-1015
Practice Address - Street 1:101 MEMORIAL HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1786
Practice Address - Country:US
Practice Address - Phone:251-343-9090
Practice Address - Fax:251-380-1015
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000028028Medicaid
ALF99688Medicare UPIN
AL000028028Medicaid
AL000028028Medicare ID - Type Unspecified