Provider Demographics
NPI:1952305468
Name:LORA, JUAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:D
Last Name:LORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:DE DIOS
Other - Last Name:LORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1130 SE 18TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5422
Mailing Address - Country:US
Mailing Address - Phone:352-732-3966
Mailing Address - Fax:352-732-6942
Practice Address - Street 1:1130 SE 18TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5422
Practice Address - Country:US
Practice Address - Phone:352-732-3966
Practice Address - Fax:352-732-6942
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032147207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54782Medicare UPIN
FL42127Medicare ID - Type Unspecified