Individual
DR. VIVIANE MAMLOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3601 4TH ST, 1A115, LUBBOCK, TX 79430-0002
(806) 743-2155
(806) 743-2117
Mailing address
PO BOX 5865, LUBBOCK, TX 79408-5865
(806) 743-2898
(806) 743-3596
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
H0597
TX
207ZP0213X
Pediatric Pathology Physician
Primary
H0597
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52453
PRESBYTERIAN COMMERCIAL
NM
05
—
52453
—
NM
01
—
80816Z
HMO BLUE
TX
01
—
82P200
BLUE CROSS & BLUE SHIELD
TX
01
—
A120
TRIWEST
—
05
—
J6446
—
NM
Enumeration date
05/24/2005
Last updated
07/12/2007
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