Healthcare Provider Details

I. General information

NPI: 1558422089
Provider Name (Legal Business Name): JOHN LORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E 32ND STREET
AUSTIN TX
78765
US

IV. Provider business mailing address

PO BOX 4268
AUSTIN TX
78765-4268
US

V. Phone/Fax

Practice location:
  • Phone: 512-404-8145
  • Fax: 512-404-8146
Mailing address:
  • Phone: 512-306-1903
  • Fax: 512-382-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD3919
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberD3919
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: