Provider Demographics
NPI:1316934854
Name:SHIRLEY-WENZEL, LORRAINE (MD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:SHIRLEY-WENZEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13409 GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3064
Mailing Address - Country:US
Mailing Address - Phone:210-492-8922
Mailing Address - Fax:
Practice Address - Street 1:13409 GEORGE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3064
Practice Address - Country:US
Practice Address - Phone:210-492-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177118001Medicaid
TX8J9993OtherBCBS
TXF42766Medicare UPIN
TX8D9956Medicare PIN