Provider Demographics
NPI:1518923275
Name:LARRAZABAL, PATRICK JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOHN
Last Name:LARRAZABAL
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 1:500 MEMORIAL CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5071
Mailing Address - Country:US
Mailing Address - Phone:386-676-2779
Mailing Address - Fax:386-676-2811
Practice Address - Street 1:500 MEMORIAL CIR
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5071
Practice Address - Country:US
Practice Address - Phone:386-676-2779
Practice Address - Fax:386-676-2811
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0086562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266766500Medicaid
FLH13844Medicare UPIN
FL266766500Medicaid