Provider Demographics
NPI:1356304935
Name:LA KIER, EARL I (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:I
Last Name:LA KIER
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 1:2151 S ALTERNATE A1A
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4112
Mailing Address - Country:US
Mailing Address - Phone:561-746-7515
Mailing Address - Fax:561-746-7875
Practice Address - Street 1:2151 S ALTERNATE A1A
Practice Address - Street 2:SUITE 1250
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4112
Practice Address - Country:US
Practice Address - Phone:561-746-7515
Practice Address - Fax:561-746-7875
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2011-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253758300Medicaid
FL41344OtherBLUE CROSS BLUE SHIELD OF FLA
FL9728683OtherGHI
FL241071OtherAVMED
FLP00088122OtherRAILROAD MEDICARE
FL253758300Medicaid
FL41344AMedicare PIN