Provider Demographics
NPI:1851385959
Name:QUIRAY, LOURDES FERRER (M D)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:FERRER
Last Name:QUIRAY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1857
Mailing Address - Country:US
Mailing Address - Phone:850-833-7400
Mailing Address - Fax:850-833-7528
Practice Address - Street 1:1221 W LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1857
Practice Address - Country:US
Practice Address - Phone:850-469-3500
Practice Address - Fax:850-595-1400
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2019-11-06
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
FLME6641208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23716OtherBLUE CROSS BLUE SHIELD
FL374028500Medicaid
FL23716Medicare ID - Type UnspecifiedLOURDES F. QUIRAY, M. D.
FL23716OtherBLUE CROSS BLUE SHIELD