Basic Information
| Provider Information | |||||||||
| NPI: | 1336242130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOUIS | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 RACQUET CLUB PKWY | ||||||||
| Address2: | |||||||||
| City: | PELHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351246185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056201085 | ||||||||
| FaxNumber: | 2056201091 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 RACQUET CLUB PKWY | ||||||||
| Address2: | |||||||||
| City: | PELHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351246185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056201085 | ||||||||
| FaxNumber: | 2056201091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 10/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | 12981 | AL | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000060991 | 05 | AL | MEDICAID |