Provider Demographics
NPI:1245210046
Name:LAROSE, PAUL E (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:LAROSE
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:PO BOX 18868
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32523-8868
Mailing Address - Country:US
Mailing Address - Phone:850-994-5660
Mailing Address - Fax:850-994-5841
Practice Address - Street 1:525 BRENT LN
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2003
Practice Address - Country:US
Practice Address - Phone:850-471-2221
Practice Address - Fax:850-471-2232
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 40352207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ113OtherVISTA
FL067040500Medicaid
FLZ113OtherHEALTHEASE
FL434705599OtherTRICARE
FLZ113OtherHEALTHY KIDS
FLZ113OtherHEALTH OPTIONS
FL160055559OtherRAILROAD MEDICARE
FLZ113OtherWELLCARE
AL59167048OtherBLUE CROSS BLUE SHIELD AL
FL17523OtherBLUE CROSS BLUE SHIELD FL
FL17523OtherBLUE CROSS BLUE SHIELD FL
FL434705599OtherTRICARE