Provider Demographics
NPI:1760493753
Name:GROW, LORI ALLISON (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ALLISON
Last Name:GROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6621
Mailing Address - Country:US
Mailing Address - Phone:352-333-5840
Mailing Address - Fax:352-333-5841
Practice Address - Street 1:6420 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6621
Practice Address - Country:US
Practice Address - Phone:352-333-5840
Practice Address - Fax:352-333-5841
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME973712085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305073OtherAVMED
FL68871OtherBCBS
FL277015600Medicaid
FLP00361049OtherMEDICARE RAILROAD
FLU8612KMedicare PIN
FLU8612PMedicare PIN
FLU8612UMedicare PIN
FLU8612VMedicare PIN
FLU8612RMedicare PIN
FLP00361049OtherMEDICARE RAILROAD
FLU8612YMedicare PIN
FLU8612MMedicare PIN
FLK6406Medicare PIN
FL305073OtherAVMED
FLU8612SMedicare PIN
FLU8612TMedicare PIN
FLU8612WMedicare PIN
FLU8612ZMedicare PIN
FLU8612NMedicare PIN