MEDICARE: LORA LEE THAXTON 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	208100000X	Physical Medicine & Rehabilitation Physician	ME139140	FL
2	208100000X	Physical Medicine & Rehabilitation Physician	35071671T	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356346514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORA LEE THAXTON M.D.

Provider Business Mailing Address
First Line	:	3361 TRULUCK PL
Second Line	:
City	:	OXFORD
State	:	FL
Zip	:	34484-3493
Country	:	US
Telephone Number	:	419-356-4767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 EL CAMINO REAL
Second Line	:
City	:	THE VILLAGES
State	:	FL
Zip	:	32159
Country	:	US
Telephone Number	:	352-751-8506
Fax Number	:	352-751-8516

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	03/13/2019

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Directions to “ LORA LEE THAXTON M.D.” Practice Location

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