Healthcare Provider Details

I. General information

NPI: 1679561880
Provider Name (Legal Business Name): LONNIE R SCHWIRTLICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14254 SPID DR STE 207
CORPUS CHRISTI TX
78418-6278
US

IV. Provider business mailing address

PO BOX 60112
CORPUS CHRISTI TX
78466-0112
US

V. Phone/Fax

Practice location:
  • Phone: 361-589-4068
  • Fax: 361-589-4079
Mailing address:
  • Phone: 361-949-0204
  • Fax: 361-857-0572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberF7376
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF7376
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberF7376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: