Provider Demographics
NPI:1336368232
Name:DORE, LUCRECIA (MD)
Entity type:Individual
Prefix:
First Name:LUCRECIA
Middle Name:
Last Name:DORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUCRECIA
Other - Middle Name:
Other - Last Name:SCRIVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18401 BELFAIR GLEN PL
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3933
Mailing Address - Country:US
Mailing Address - Phone:813-943-8624
Mailing Address - Fax:
Practice Address - Street 1:18401 BELFAIR GLEN PL
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-3933
Practice Address - Country:US
Practice Address - Phone:813-943-8624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230385402084P0800X
FLME 1002422084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47495OtherBCBS OF FLORIDA
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER
FLAK061ZMedicare PIN
FL281163400Medicaid
FL1497748743OtherGROUP NPI NUMBER / LRHSI