Provider Demographics
NPI:1477979664
Name:LARZELERE, WILLIAM JUDE (OMD, LAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JUDE
Last Name:LARZELERE
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 W PALMETTO PARK RD
Mailing Address - Street 2:#412
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3768
Mailing Address - Country:US
Mailing Address - Phone:954-650-0542
Mailing Address - Fax:
Practice Address - Street 1:290 W PALMETTO PARK RD
Practice Address - Street 2:#412
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3768
Practice Address - Country:US
Practice Address - Phone:954-650-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist