Provider Demographics
NPI:1710953179
Name:BROWN, LORA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:727-440-5410
Mailing Address - Fax:
Practice Address - Street 1:625 6TH AVE S, SUITE 475
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-209-5470
Practice Address - Fax:727-209-5471
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 85743208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62965OtherBCBS FL
FLN5401OtherHF MEDICARE
FL1750716619OtherGROUP NPPI