Provider Demographics
NPI:1255149209
Name:LORA TAVERAS, NORMA M (MD)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:M
Last Name:LORA TAVERAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7101 SW 77TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-2721
Mailing Address - Country:US
Mailing Address - Phone:786-417-8663
Mailing Address - Fax:407-962-4446
Practice Address - Street 1:5249 CONWAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2202
Practice Address - Country:US
Practice Address - Phone:407-931-0444
Practice Address - Fax:407-962-4446
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLACN1685208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice