Provider Demographics
NPI:1770698771
Name:FAROLAN, LORENZO M (MD)
Entity type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:M
Last Name:FAROLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4470
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4470
Mailing Address - Country:US
Mailing Address - Phone:956-627-2509
Mailing Address - Fax:956-627-3751
Practice Address - Street 1:2616 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9122
Practice Address - Country:US
Practice Address - Phone:956-687-2976
Practice Address - Fax:956-994-1338
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF52012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143798002Medicaid
TX8116N0Medicare ID - Type UnspecifiedMC
B22638Medicare UPIN