Provider Demographics
NPI:1760482640
Name:LO, ERWIN (MD)
Entity type:Individual
Prefix:DR
First Name:ERWIN
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 S 11TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3723
Mailing Address - Country:US
Mailing Address - Phone:409-234-7088
Mailing Address - Fax:409-898-0177
Practice Address - Street 1:755 S 11TH ST STE 102
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3723
Practice Address - Country:US
Practice Address - Phone:409-234-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1373174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150970502Medicaid
TX1163373004OtherCIGNA
TX148913001Medicaid
TX8F3763OtherBCBS
TXA006OtherTRICARE/CHAMPUS
TX2850217OtherAETNA
TXP00068057OtherRAILROAD MEDICARE
TX0020HDOtherGROUP BCBS
TX148913001Medicaid
TX0020HDOtherGROUP BCBS
TXH59422Medicare UPIN