Provider Demographics
NPI:1285675330
Name:BENNETT, LORNA ODETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORNA
Middle Name:ODETTE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:365 CITRUS TOWER BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6532
Mailing Address - Country:US
Mailing Address - Phone:352-404-7728
Mailing Address - Fax:352-404-7724
Practice Address - Street 1:365 CITRUS TOWER BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6532
Practice Address - Country:US
Practice Address - Phone:352-404-7728
Practice Address - Fax:352-404-7724
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91225208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270887600Medicaid
FL03426OtherBCBS