Basic Information
| Provider Information | |||||||||
| NPI: | 1003869686 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPOOR | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W. KENNEDY BVLD. | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336092501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138441385 | ||||||||
| FaxNumber: | 8132540230 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W. KENNEDY BLVD. | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336092501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138441385 | ||||||||
| FaxNumber: | 8132540230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 12/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS9996 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1012659340001 | 05 | PA | MEDICAID | 278198100 | 05 | FL | MEDICAID | AD0792 | 01 | FL | MEDICARE | OTHER |