MEDICARE: DR. LORI RENEE ALLEMBAUGH D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	M6494	TX

General Provider Information

NPI Number	:	1740495910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI RENEE ALLEMBAUGH D.O.

Provider Business Mailing Address
First Line	:	501 AIR PARK AVE
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-3000
Country	:	US
Telephone Number	:	903-455-1100
Fax Number	:	903-408-1129

Provider Business Practice Location Address
First Line	:	5101 WELLINGTON ST UNIT C
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-6040
Country	:	US
Telephone Number	:	903-455-3261
Fax Number	:	903-455-0211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	01/17/2025

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