Provider Demographics
NPI:1689675738
Name:LORIZ, MARK F (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:LORIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5935
Mailing Address - Country:US
Mailing Address - Phone:850-477-7042
Mailing Address - Fax:850-474-9060
Practice Address - Street 1:4901 GRANDE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5935
Practice Address - Country:US
Practice Address - Phone:850-477-7042
Practice Address - Fax:850-474-9060
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53947207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047612900Medicaid
FLZ190OtherHEALTH FIRST NETWORK
AL009000370Medicaid
FL050015909OtherRAILROAD MEDICARE
FL08266OtherBLUECROSS & BLUE SHIELD
AL59092919OtherBLUECROSS & BLUESHIELD
E22422Medicare UPIN
FL050015909OtherRAILROAD MEDICARE