Provider Demographics
NPI:1295873222
Name:LAO SAM, FLORENCIO (M D)
Entity type:Individual
Prefix:DR
First Name:FLORENCIO
Middle Name:
Last Name:LAO SAM
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:138 AVE WINSTON CHURCHILL PMB 228
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-257-1840
Mailing Address - Fax:787-701-4740
Practice Address - Street 1:CAROLINA SHOPP CTR
Practice Address - Street 2:MULTIPISO OF 309 AVE 65 INFANTERIA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5672
Practice Address - Country:US
Practice Address - Phone:787-257-1840
Practice Address - Fax:787-701-4740
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6959 IN 1983208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0098576Medicare PIN
PRD08779Medicare UPIN