Provider Demographics
NPI:1982081683
Name:LAROCQUE, RAYMOND TIMOTHY (MD)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:TIMOTHY
Last Name:LAROCQUE
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:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:400 W 16TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2745
Practice Address - Country:US
Practice Address - Phone:719-595-7580
Practice Address - Fax:719-545-0176
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2019-10-01
Deactivation Date:2015-12-09
Deactivation Code:
Reactivation Date:2015-12-31
Provider Licenses
StateLicense IDTaxonomies
CODR.0060701207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine