Provider Demographics
NPI:1790744878
Name:LARACH, SERGIO W (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:W
Last Name:LARACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N DEAN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3710
Mailing Address - Country:US
Mailing Address - Phone:407-384-7388
Mailing Address - Fax:407-384-7391
Practice Address - Street 1:100 N DEAN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3710
Practice Address - Country:US
Practice Address - Phone:407-384-7388
Practice Address - Fax:407-384-7391
Is Sole Proprietor?:No
Enumeration Date:2006-03-19
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME25149208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D55470Medicare UPIN
FL48835BMedicare PIN