Individual
DR. LORI WASSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1401 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2113
(713) 432-1100
(713) 432-0221
Mailing address
14275 MIDWAY RD, SUITE 400, ADDISON, TX 75001-3614
(214) 932-8029
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
H8497
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116816304
—
TX
05
—
121877803
—
TX
01
—
220030725
RR MEDICARE
TX
01
—
8B0320
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/30/2005
Last updated
06/26/2015
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