Provider Demographics
NPI:1114978343
Name:BACHLE, LAWRENCE R (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:R
Last Name:BACHLE
Suffix:
Gender:M
Credentials:DO
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 510669
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0669
Mailing Address - Country:US
Mailing Address - Phone:941-764-9560
Mailing Address - Fax:941-764-1854
Practice Address - Street 1:25097 OLYMPIA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3903
Practice Address - Country:US
Practice Address - Phone:941-205-2620
Practice Address - Fax:941-206-2630
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6291207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37095230Medicaid
FLDE7887OtherRR MEDICARE GRP #
FLP00316034OtherRR MEDICARE
FLE35257Medicare UPIN
FL80688YMedicare ID - Type Unspecified