Provider Demographics
NPI:1255537890
Name:LORENZINO, JON D (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:D
Last Name:LORENZINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4123
Mailing Address - Country:US
Mailing Address - Phone:417-869-2000
Mailing Address - Fax:417-881-1850
Practice Address - Street 1:607 W BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4123
Practice Address - Country:US
Practice Address - Phone:417-869-2000
Practice Address - Fax:417-881-1850
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001022242207ZP0102X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO141340006Medicare PIN
OKOKA104604Medicare UPIN