Provider Demographics
NPI:1336242130
Name:LOUIS, LORI R (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:LOUIS
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 1:30 RACQUET CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-6185
Mailing Address - Country:US
Mailing Address - Phone:205-620-1085
Mailing Address - Fax:205-620-1091
Practice Address - Street 1:30 RACQUET CLUB PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-6185
Practice Address - Country:US
Practice Address - Phone:205-620-1085
Practice Address - Fax:205-620-1091
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL129812083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060991Medicaid
AL102G709903Medicare PIN
AL102I849902Medicare UPIN
E54495Medicare UPIN
AL60991Medicare ID - Type Unspecified