Provider Demographics
NPI:1588658496
Name:HERSHORIN, LAURA L (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:L
Last Name:HERSHORIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 919395
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9395
Mailing Address - Country:US
Mailing Address - Phone:941-364-4411
Mailing Address - Fax:941-364-4466
Practice Address - Street 1:6120 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9707
Practice Address - Country:US
Practice Address - Phone:941-364-4411
Practice Address - Fax:941-364-4466
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01589OtherBCBS
FL01589OtherBCBS
FL01589YMedicare UPIN
FLG62641Medicare UPIN
FLG62641Medicare UPIN