Provider Demographics
NPI:1578705141
Name:LAROCHE, GREGGY DENIS
Entity Type:Individual
Prefix:
First Name:GREGGY
Middle Name:DENIS
Last Name:LAROCHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 COMMODITY CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9001
Mailing Address - Country:US
Mailing Address - Phone:407-354-0717
Mailing Address - Fax:
Practice Address - Street 1:8500 COMMODITY CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9001
Practice Address - Country:US
Practice Address - Phone:407-354-0717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-29
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0074395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program