Provider Demographics
NPI:1073500435
Name:LAROE, CYNTHIA A (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:LAROE
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:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-1245
Mailing Address - Country:US
Mailing Address - Phone:352-508-5046
Mailing Address - Fax:352-508-5048
Practice Address - Street 1:1840 CLASSIQUE LANE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-1924
Practice Address - Country:US
Practice Address - Phone:352-508-5046
Practice Address - Fax:352-508-5048
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262396000Medicaid
FL262396000Medicaid