Provider Demographics
NPI:1518407428
Name:LAQUIS, GEORGE ANTHONY (MD, CM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ANTHONY
Last Name:LAQUIS
Suffix:
Gender:M
Credentials:MD, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 E LEITNER DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2045
Mailing Address - Country:US
Mailing Address - Phone:954-856-4588
Mailing Address - Fax:954-341-4129
Practice Address - Street 1:5412 E LEITNER DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2045
Practice Address - Country:US
Practice Address - Phone:954-856-4588
Practice Address - Fax:954-341-4129
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33302405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048893300Medicaid
FLE14548Medicare UPIN