Provider Demographics
NPI:1730163346
Name:SOMMERFELDT, LORRAINE ARLENE (MD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:ARLENE
Last Name:SOMMERFELDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 W AMARILLO BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1901
Mailing Address - Country:US
Mailing Address - Phone:806-355-2922
Mailing Address - Fax:806-353-9593
Practice Address - Street 1:6103 W AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1901
Practice Address - Country:US
Practice Address - Phone:806-355-2922
Practice Address - Fax:806-353-9593
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH88462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0982308-02Medicaid
TX00706WMedicare ID - Type Unspecified
TX0982308-02Medicaid
TX853169Medicare PIN