MEDICARE: DR. HENRY LORA MD

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	208D00000X	General Practice Physician	ME82996	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11196017	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578512935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY LORA MD

Provider Business Mailing Address
First Line	:	951 NE 167TH ST
Second Line	:	SUITE 102
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3711
Country	:	US
Telephone Number	:	305-944-1122
Fax Number	:	305-944-1133

Provider Business Practice Location Address
First Line	:	951 NE 167TH ST
Second Line	:	SUITE 102
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3711
Country	:	US
Telephone Number	:	305-944-1122
Fax Number	:	305-944-1133

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	03/05/2015

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