Individual
MRS. LORI P MAULDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
920
SC
363AM0700X
Medical Physician Assistant
920
SC
Other
Enumeration date
05/12/2006
Last updated
04/30/2008
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