Provider Demographics
NPI:1497741219
Name:PRINC, LORA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:JEAN
Last Name:PRINC
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6545 FRANCE AVE S
Mailing Address - Street 2:SUITE 540
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2131
Mailing Address - Country:US
Mailing Address - Phone:952-927-4045
Mailing Address - Fax:952-927-0867
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SUITE 540
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-927-4045
Practice Address - Fax:952-927-0867
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2015-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN47558207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN630182700Medicaid
MNI39589Medicare UPIN