Provider Demographics
NPI:1073723821
Name:LARUE AND LARUE PEDIATRICS
Entity Type:Organization
Organization Name:LARUE AND LARUE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LARUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-293-3909
Mailing Address - Street 1:400 AVENUE K SE
Mailing Address - Street 2:STE 5
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4146
Mailing Address - Country:US
Mailing Address - Phone:863-293-3909
Mailing Address - Fax:863-293-1909
Practice Address - Street 1:400 AVENUE K SE
Practice Address - Street 2:STE 5
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4146
Practice Address - Country:US
Practice Address - Phone:863-293-3909
Practice Address - Fax:863-293-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045287174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty