Provider Demographics
NPI:1548293905
Name:DE LORENZO, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:DE LORENZO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:BAMC - 3851 ROGER BROOKE DRIVE
Mailing Address - Street 2:MCHE-QD (CREDS)
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6200
Mailing Address - Country:US
Mailing Address - Phone:210-916-1006
Mailing Address - Fax:210-916-2265
Practice Address - Street 1:BAMC - 3851 ROGER BROOKE DRIVE
Practice Address - Street 2:MCHE-QD (CREDS)
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-1006
Practice Address - Fax:210-916-2265
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-11-22
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Provider Licenses
StateLicense IDTaxonomies
TXK3708207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF16442Medicare UPIN