Provider Demographics
NPI:1609026590
Name:LORENZ, PAUL P (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:P
Last Name:LORENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 ROSEMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8378
Mailing Address - Country:US
Mailing Address - Phone:239-768-6844
Mailing Address - Fax:
Practice Address - Street 1:12010 ROSEMOUNT DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8378
Practice Address - Country:US
Practice Address - Phone:239-768-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL3581089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC38944Medicare UPIN
298701Medicare PIN