Healthcare Provider Details

I. General information

NPI: 1669423273
Provider Name (Legal Business Name): MAURA JEAN LOFARO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAURA LOFARO LOFARO HARROWER

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E BROADWAY AVE SUITE 108
JACKSON WY
83001-8640
US

IV. Provider business mailing address

PO BOX 1844
JACKSON WY
83001-1844
US

V. Phone/Fax

Practice location:
  • Phone: 307-734-1005
  • Fax: 307-734-1165
Mailing address:
  • Phone: 307-734-1005
  • Fax: 307-734-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5889A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number5889A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: