Provider Demographics
NPI:1457312969
Name:LORENZ, JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:LORENZ
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 1:10000 W COLONIAL DR
Mailing Address - Street 2:STE 282
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3432
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:407-650-1307
Practice Address - Street 1:1222 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1215
Practice Address - Country:US
Practice Address - Phone:407-351-5384
Practice Address - Fax:407-445-0321
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42458207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068419800Medicaid
FLME42458OtherMEDICAL LICENSE
FLME42458OtherMEDICAL LICENSE
FL47478UMedicare PIN
FL47478TMedicare PIN
A64588Medicare UPIN
FL47478WMedicare PIN