Individual
DR. LORI L. WICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 847408, DALLAS, TX 75284-7408
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
H4792
TX
2080P0203X
Pediatric Critical Care Medicine Physician
H4792
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255762-03
CSHCN
TX
05
—
1255762-04
—
TX
01
—
370017482
RR/MEDICARE
TX
01
—
84W321
BLUE SHIELD
TX
01
—
8L14217
MEDICARE PTAN
TX
Enumeration date
04/03/2006
Last updated
08/21/2009
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