Provider Demographics
NPI:1700129228
Name:STANDLEE, LOREN C (MD)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:C
Last Name:STANDLEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 S 61ST ST STE 109
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6856
Mailing Address - Country:US
Mailing Address - Phone:918-804-2525
Mailing Address - Fax:
Practice Address - Street 1:2027 S 61ST ST STE 109
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6856
Practice Address - Country:US
Practice Address - Phone:254-228-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8657208D00000X
390200000X
NE28090208D00000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171000000XOther Service ProvidersMilitary Health Care Provider