Provider Demographics
NPI:1073729943
Name:FLORENCE, LAUREN OPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:OPAL
Last Name:FLORENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 EAST 3900 SOUTH
Mailing Address - Street 2:SUITE #301
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1362
Mailing Address - Country:US
Mailing Address - Phone:801-264-9111
Mailing Address - Fax:801-685-0440
Practice Address - Street 1:1250 EAST 3900 SOUTH
Practice Address - Street 2:SUITE #301
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1362
Practice Address - Country:US
Practice Address - Phone:801-264-9111
Practice Address - Fax:801-685-0440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1802912086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT180291OtherPHYSICIAN AND SURGEON