Provider Demographics
NPI:1447276399
Name:LORIMER, WISHARD S III (MD)
Entity type:Individual
Prefix:
First Name:WISHARD
Middle Name:S
Last Name:LORIMER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-294-7425
Practice Address - Street 1:6601 DAN DANCIGER
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-4953
Practice Address - Country:US
Practice Address - Phone:817-294-2531
Practice Address - Fax:817-294-7425
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE2685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080194435OtherRAILROAD MEDICARE
TX099994803Medicaid