Provider Demographics
NPI:1265475511
Name:LARA, CARLOS ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ENRIQUE
Last Name:LARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8599 SW HIGHWAY 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-7729
Mailing Address - Country:US
Mailing Address - Phone:352-861-0043
Mailing Address - Fax:352-861-8750
Practice Address - Street 1:8599 SW HIGHWAY 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-7729
Practice Address - Country:US
Practice Address - Phone:352-861-0043
Practice Address - Fax:352-861-8750
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276904200Medicaid
FLME94543OtherSTATE LICENSE
FLME94543OtherSTATE LICENSE
FL34002YMedicare PIN