Provider Demographics
NPI:1932240926
Name:SERGIO W. LARACH, M.D., PA
Entity Type:Organization
Organization Name:SERGIO W. LARACH, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:W
Authorized Official - Last Name:LARACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-797-5893
Mailing Address - Street 1:243 NOB HILL CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4430
Mailing Address - Country:US
Mailing Address - Phone:407-797-5893
Mailing Address - Fax:407-884-5337
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-797-5893
Practice Address - Fax:407-884-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6753Medicare PIN