Provider Demographics
NPI:1427749639
Name:LORIAL, JEAN RENE SR (PA, FSA,MD)
Entity type:Individual
Prefix:DR
First Name:JEAN RENE
Middle Name:
Last Name:LORIAL
Suffix:SR
Gender:M
Credentials:PA, FSA,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 CIMARRON TRL APT 606
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-2727
Mailing Address - Country:US
Mailing Address - Phone:812-887-6081
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE PADRE BERRIOS
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1644
Practice Address - Country:US
Practice Address - Phone:787-857-0429
Practice Address - Fax:787-857-4949
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-263246ZC0007X
PR001660363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty