Provider Demographics
NPI:1134133408
Name:LAROCHE, EDDY (MD)
Entity Type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:LAROCHE
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 1:605 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3211
Mailing Address - Country:US
Mailing Address - Phone:352-796-9990
Mailing Address - Fax:352-796-2226
Practice Address - Street 1:605 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3211
Practice Address - Country:US
Practice Address - Phone:352-796-9990
Practice Address - Fax:352-796-2226
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080071835OtherRAILROAD MEDICARE
3515OtherROCHESTER BLUE SHIELD
NY11738BMedicare PIN
G15774Medicare UPIN
NYRA2225Medicare PIN
3515OtherROCHESTER BLUE SHIELD
NYP010198048OtherBLUE CHOICE
NY01610622Medicaid
NY11738BMedicare PIN
103469900OtherUS DEPT OF LABOR
G15774Medicare UPIN
NY1015648FOtherPREFERRED CARE
080071835OtherRAILROAD MEDICARE
NYRA2225Medicare PIN