Provider Demographics
NPI:1922100106
Name:LARRAURI, JUAN MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:LARRAURI
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 1:3136 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-8027
Mailing Address - Country:US
Mailing Address - Phone:305-294-1041
Mailing Address - Fax:305-293-0990
Practice Address - Street 1:3136 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-8027
Practice Address - Country:US
Practice Address - Phone:305-294-1041
Practice Address - Fax:305-293-0990
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09794OtherINDIVIDUAL PROVIDER NUMBE
FL062142100Medicaid
FLKO536Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL062142100Medicaid