Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086X0206X | Surgical Oncologist | 11465 | MT |
N | 2086X0206X | Surgical Oncologist | MD19902 | ME |
Y | 2086X0206X | Surgical Oncologist | N4049 | TX |
NPI | 1336343235 |
---|---|
Provider Name | Loren L Rourke |
First Address | Dallas, TX 75391-1230 |
Second Address | Shenandoah, TX 77380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 21/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205095701 | (05) | TX |
205095702 | (05) | TX |
205095704 | (05) | TX |
205095705 | (05) | TX |
8FK213 | BCBS (01) | TX |
8GD975 | BCBS (01) | TX |
N4049 | STATE LICENSE (01) | TX |