Individual
LORI A GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
719 RODEL CV STE 2001, LAKE MARY, FL 32746-5716
(407) 878-4720
(407) 878-4732
Mailing address
719 RODEL CV STE 2001, LAKE MARY, FL 32746-5716
(407) 878-4720
(407) 878-4732
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO3334
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
PO3334
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001457300
—
FL
01
—
6500S
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/20/2009
Last updated
05/22/2020
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