MEDICARE: DR. LORA OVERTON PC

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	207VG0400X	Gynecology Physician	02001611	IN

General Provider Information

NPI Number	:	1346584638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. LORA OVERTON PC

Provider Business Mailing Address
First Line	:	PO BOX 112
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47308-0112
Country	:	US
Telephone Number	:	765-284-0493
Fax Number	:	765-284-2434

Provider Business Practice Location Address
First Line	:	3217 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5427
Country	:	US
Telephone Number	:	260-490-1524
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	LORA OVERTON
Credential	:	DO
Telephone Number	:	260-490-1524

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	11/27/2012

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