Provider Demographics
NPI:1154319887
Name:SASSER, LONA RAE (DO)
Entity Type:Individual
Prefix:
First Name:LONA
Middle Name:RAE
Last Name:SASSER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 N UNIVERSITY DR
Mailing Address - Street 2:#308
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5086
Mailing Address - Country:US
Mailing Address - Phone:954-340-1050
Mailing Address - Fax:954-340-5275
Practice Address - Street 1:3111 N UNIVERSITY DR
Practice Address - Street 2:#308
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5086
Practice Address - Country:US
Practice Address - Phone:954-340-1050
Practice Address - Fax:954-340-5275
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7980207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2609024100Medicaid
78598Medicare ID - Type Unspecified
H095097Medicare UPIN