Provider Demographics
NPI:1023067303
Name:LORENZEN, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LORENZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:301B RICHLAND WEST CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7919
Practice Address - Country:US
Practice Address - Phone:254-772-2722
Practice Address - Fax:254-772-4075
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE8675208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00MF72OtherBLUE CROSS BLUE SHIELD
TX0525246OtherUNITED HEALTHCARE
TX6909402OtherCIGNA
TX20362682OtherBEECH STREET
TX742171395001OtherHUMANA/MILITARY-TRICARE
B24473Medicare UPIN