Provider Demographics
NPI:1578512935
Name:LORA, HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:LORA
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 1:951 NE 167TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3711
Mailing Address - Country:US
Mailing Address - Phone:305-944-1122
Mailing Address - Fax:305-944-1133
Practice Address - Street 1:951 NE 167TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3711
Practice Address - Country:US
Practice Address - Phone:305-944-1122
Practice Address - Fax:305-944-1133
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82996208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
11196017OtherCAQH
FL2790483000Medicaid
FL2790483000Medicaid
FLH91876Medicare UPIN