Provider Demographics
NPI:1386688695
Name:MCPHAUL, LARON W (MD)
Entity Type:Individual
Prefix:
First Name:LARON
Middle Name:W
Last Name:MCPHAUL
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 1:21840 NORMANDIE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-222-5015
Mailing Address - Fax:310-328-1415
Practice Address - Street 1:21840 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-222-5015
Practice Address - Fax:310-328-1415
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57536207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G575360Medicaid
CAWG57536CMedicare ID - Type UnspecifiedPPIN
CAWG57536EMedicare ID - Type UnspecifiedPPIN
CAWG57536DMedicare ID - Type UnspecifiedPPIN
CA00G575360Medicaid