Provider Demographics
NPI:1114196185
Name:LORENZ, GIOVANNI (DO)
Entity type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:
Last Name:LORENZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GIOVANNI
Other - Middle Name:E
Other - Last Name:LORENZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5150 BROADWAY # 184
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5710
Mailing Address - Country:US
Mailing Address - Phone:210-292-4482
Mailing Address - Fax:
Practice Address - Street 1:1100 WILFORD HALL LOOP
Practice Address - Street 2:
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-6225
Practice Address - Fax:102-927-9642
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL0515174400000X
CA20A105352085R0202X
IADO-057092085R0202X
IL0361618372085R0202X
NY310352-12085R0202X
OH340129472085R0202X
VA01022076952085R0202X
CACA20A10535208D00000X
TXR96452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice