Provider Demographics
NPI:1629708110
Name:LAREAU, JACOB ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ROBERT
Last Name:LAREAU
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:161 ROYAL HTS
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-4923
Mailing Address - Country:US
Mailing Address - Phone:413-427-1114
Mailing Address - Fax:
Practice Address - Street 1:SPORTSMEDICINE ATLANTIC ORTHOPAEDICS, P.A.
Practice Address - Street 2:1900 LAFAYETTE ROAD SUITE A
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-0380
Practice Address - Country:US
Practice Address - Phone:603-431-3347
Practice Address - Fax:603-431-3347
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-30
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant