Basic Information
| Provider Information | |||||||||
| NPI: | 1891875357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LORENZ | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | SIDNEY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7862A JUST CAUSE DR. | ||||||||
| Address2: | |||||||||
| City: | FT. CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206091639 | ||||||||
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| Practice Location | |||||||||
| Address1: | EVANS ARMY COMMUNITY HOSPITAL (EACH) USA MEDDAC | ||||||||
| Address2: | DIRAIMONDO FAMILY MEDICINE CLINIC, 1041 BARKLEY AVE. | ||||||||
| City: | FT. CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194572273 | ||||||||
| FaxNumber: | 7195243526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 3470 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.