Provider Demographics
NPI:1851386684
Name:LARA, MARIE-ALICE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE-ALICE
Middle Name:
Last Name:LARA
Suffix:
Gender:F
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:PO BOX 848127
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33084-0127
Mailing Address - Country:US
Mailing Address - Phone:954-517-9166
Mailing Address - Fax:954-517-9167
Practice Address - Street 1:10000 STIRLING RD
Practice Address - Street 2:SUITE 3
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33024-8067
Practice Address - Country:US
Practice Address - Phone:954-517-9166
Practice Address - Fax:954-517-9167
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79139208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35540OtherBLUE CROSS BLUE SHIELD
FL1722315001OtherCIGNA
FL274662OtherWELLCARE
FL7477630OtherAETNA
FL2039274OtherUNITED HEALTH CARE
FL295786OtherAV-MED
FL170211OtherHUMANA
FL35540OtherBLUE CROSS BLUE SHIELD
FL295786OtherAV-MED