Provider Demographics
NPI:1043241235
Name:HAROLD, LOU C (MD)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:C
Last Name:HAROLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 BLACKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4518
Mailing Address - Country:US
Mailing Address - Phone:407-839-3700
Mailing Address - Fax:407-839-0640
Practice Address - Street 1:1173 BLACKWOOD AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4518
Practice Address - Country:US
Practice Address - Phone:407-839-3700
Practice Address - Fax:407-839-0640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47297208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL208600000XOtherTAXONOMY
FL049923400Medicaid
FL04059AMedicare ID - Type UnspecifiedMEDICARE
FL208600000XOtherTAXONOMY