MEDICARE: DR. LAURA L. HERSHORIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME92603	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01589	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1588658496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA L. HERSHORIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 919395
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-9395
Country	:	US
Telephone Number	:	941-364-4411
Fax Number	:	941-364-4466

Provider Business Practice Location Address
First Line	:	6120 53RD AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-9707
Country	:	US
Telephone Number	:	941-364-4411
Fax Number	:	941-364-4466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/30/2015

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