Provider Demographics
NPI:1275054785
Name:GANRY, LAURENT
Entity Type:Individual
Prefix:DR
First Name:LAURENT
Middle Name:
Last Name:GANRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 RIVERSIDE AVENUE
Mailing Address - Street 2:APARTMENT 4204
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204
Mailing Address - Country:US
Mailing Address - Phone:904-775-6359
Mailing Address - Fax:
Practice Address - Street 1:2054 RIVERSIDE AVE APT 4204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4445
Practice Address - Country:US
Practice Address - Phone:904-775-6359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN25646390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program