Provider Demographics
NPI:1982880944
Name:LARA J FIX DO PA
Entity Type:Organization
Organization Name:LARA J FIX DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-192-9355
Mailing Address - Street 1:PO BOX 1637
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-1637
Mailing Address - Country:US
Mailing Address - Phone:772-219-9355
Mailing Address - Fax:772-219-9357
Practice Address - Street 1:816 SE OCEAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2428
Practice Address - Country:US
Practice Address - Phone:772-219-9355
Practice Address - Fax:772-219-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4995388OtherCIGNA