Provider Demographics
NPI:1427143908
Name:LORA, FERNANDO JOSE (MD)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:JOSE
Last Name:LORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:FERNANDO
Other - Middle Name:JOSE
Other - Last Name:LORA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8300 W FLAGLER ST
Mailing Address - Street 2:STE 175
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-6000
Mailing Address - Country:US
Mailing Address - Phone:305-220-0300
Mailing Address - Fax:305-220-1472
Practice Address - Street 1:8300 W. FLAGLER ST
Practice Address - Street 2:SUITE 175
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2098
Practice Address - Country:US
Practice Address - Phone:305-220-0300
Practice Address - Fax:305-220-1472
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045837174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042148100Medicaid
FLD64027Medicare UPIN