MEDICARE: DR. GEORGE ANTHONY LAQUIS M.D, C.M

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	405300000X	Prevention Professional	33302	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518407428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE ANTHONY LAQUIS M.D, C.M

Provider Business Mailing Address
First Line	:	5412 E LEITNER DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2045
Country	:	US
Telephone Number	:	954-856-4588
Fax Number	:	954-341-4129

Provider Business Practice Location Address
First Line	:	5412 E LEITNER DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2045
Country	:	US
Telephone Number	:	954-856-4588
Fax Number	:	954-341-4129

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/27/2017

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