Healthcare Provider Details

I. General information

NPI: 1578512935
Provider Name (Legal Business Name): HENRY LORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NE 167TH ST SUITE 102
NORTH MIAMI BEACH FL
33162-3711
US

IV. Provider business mailing address

951 NE 167TH ST SUITE 102
NORTH MIAMI BEACH FL
33162-3711
US

V. Phone/Fax

Practice location:
  • Phone: 305-944-1122
  • Fax: 305-944-1133
Mailing address:
  • Phone: 305-944-1122
  • Fax: 305-944-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME82996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: