Provider Demographics
NPI:1801886569
Name:CONCHA, LOURDES B (MD)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:B
Last Name:CONCHA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1821 S SESAME SQUARE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8407
Mailing Address - Country:US
Mailing Address - Phone:956-412-7099
Mailing Address - Fax:956-412-7488
Practice Address - Street 1:1821 S SESAME SQUARE
Practice Address - Street 2:SUITE 9
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8407
Practice Address - Country:US
Practice Address - Phone:956-412-7099
Practice Address - Fax:956-412-7488
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL8018207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166028402Medicaid
TX8BB671OtherBCBX
TX8BB671OtherBCBX