Individual
DR. JEAN RENE LORIAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA, FSA,MD
Contact information
Practice address
5847 S 16TH ST, PHOENIX, AZ 85040-3512
(602) 609-4107
Mailing address
6211 CARD BLVD, INDIANAPOLIS, IN 46221-6102
(812) 887-6081
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
21-263
WI
363AM0700X
Medical Physician Assistant
001660
PR
363AM0700X
Medical Physician Assistant
Primary
10338
AZ
363AM0700X
Medical Physician Assistant
PACN21
FL
Other
Enumeration date
05/17/2023
Last updated
05/31/2025
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