Provider Demographics
NPI:1295825842
Name:LARMOYEUX CLINIC PA
Entity Type:Organization
Organization Name:LARMOYEUX CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TRAINER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:904-353-5696
Mailing Address - Street 1:124 E ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3118
Mailing Address - Country:US
Mailing Address - Phone:904-353-5696
Mailing Address - Fax:904-353-2844
Practice Address - Street 1:124 E ASHLEY ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3118
Practice Address - Country:US
Practice Address - Phone:904-353-5696
Practice Address - Fax:904-353-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1951AMedicare PIN
FL99569Medicare ID - Type UnspecifiedFIRST COAST SERVICE OPT