Provider Demographics
NPI:1003043134
Name:POWELL, LORRAINE E (MD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:E
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORRAINE
Other - Middle Name:EDRY
Other - Last Name:SALEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1912 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1324
Mailing Address - Country:US
Mailing Address - Phone:512-451-5161
Mailing Address - Fax:512-451-1258
Practice Address - Street 1:1912 W 35TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1324
Practice Address - Country:US
Practice Address - Phone:512-451-5161
Practice Address - Fax:512-451-1258
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10035458208000000X
TXP4231208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX306554201Medicaid
TX306554201Medicaid