Healthcare Provider Details

I. General information

NPI: 1295771582
Provider Name (Legal Business Name): FREDERICK S LORENZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N L ROGERS WELLS BLVD
GLASGOW KY
42141-1300
US

IV. Provider business mailing address

310 N L ROGERS WELLS BLVD
GLASGOW KY
42141-1300
US

V. Phone/Fax

Practice location:
  • Phone: 270-659-5885
  • Fax: 270-659-5852
Mailing address:
  • Phone: 270-659-5885
  • Fax: 270-659-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number47589
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35084750
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2020038084
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: