Provider Demographics
NPI:1144586629
Name:CARIBE ID LLC
Entity Type:Organization
Organization Name:CARIBE ID LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-669-6800
Mailing Address - Street 1:1840 MEASE DRIVE
Mailing Address - Street 2:SUITE 319
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6605
Mailing Address - Country:US
Mailing Address - Phone:727-669-6800
Mailing Address - Fax:727-669-2540
Practice Address - Street 1:1840 MEASE DRIVE
Practice Address - Street 2:SUITE 319
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6605
Practice Address - Country:US
Practice Address - Phone:727-669-6800
Practice Address - Fax:727-669-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI=========OtherTAX ID