Provider Demographics
NPI:1336146786
Name:WASSON, LORI (DO)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:WASSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1401 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2113
Practice Address - Country:US
Practice Address - Phone:713-432-1100
Practice Address - Fax:713-432-0221
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8497207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121877803Medicaid
TX8B0320OtherBLUE CROSS BLUE SHIELD
TX116816304Medicaid
TX220030725OtherRR MEDICARE
TXF93414Medicare UPIN
TX116816304Medicaid