Provider Demographics
NPI:1699882639
Name:ADCOCK, LORI D (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:D
Last Name:ADCOCK
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:PO BOX 52307
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79710-0000
Mailing Address - Country:US
Mailing Address - Phone:432-697-8988
Mailing Address - Fax:432-697-8950
Practice Address - Street 1:303 VETERANS AIRPARK LN
Practice Address - Street 2:SUITE 4109
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-0000
Practice Address - Country:US
Practice Address - Phone:432-697-8988
Practice Address - Fax:432-697-8950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5631174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A4550OtherBCBS TEXAS
TXE03352Medicare UPIN
TX8A4550OtherBCBS TEXAS