Provider Demographics
NPI:1023054913
Name:WHITLEY, LORI S (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:S
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:K
Other - Last Name:SEEFELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3917 WEST RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2275
Mailing Address - Country:US
Mailing Address - Phone:505-662-4351
Mailing Address - Fax:505-662-2932
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-662-4351
Practice Address - Fax:505-662-2932
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0151207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00636371Medicaid
I57853Medicare UPIN
347625701Medicare PIN