Individual
DR. LORI E FANTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MPH
Contact information
Practice address
1501 N CAMPBELL AVE, TUCSON, AZ 85724-1544
(410) 328-9105
(410) 328-4430
Mailing address
P.O. BOX 245039, 1501 N. CAMPBELL AVE., TUCSON, AZ 85722
(520) 626-6887
(520) 626-5183
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
52406
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
066631900
—
MD
05
—
4420540
—
DC
01
—
520948-01 & 02
BLUE CROSS/BLUE SHIELD
MD
Enumeration date
05/05/2006
Last updated
07/21/2022
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