Healthcare Provider Details

I. General information

NPI: 1902829708
Provider Name (Legal Business Name): ERIC LARUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVENUE K SE STE 8
WINTER HAVEN FL
33880-4123
US

IV. Provider business mailing address

400 AVENUE K SE STE 8
WINTER HAVEN FL
33880-4123
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-3111
  • Fax: 863-662-3975
Mailing address:
  • Phone: 863-294-3111
  • Fax: 863-662-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME0045287
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME0045287
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0045287
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberME0045287
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberME0045287
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207QD0401X
TaxonomyDiabetology Physician
License NumberME0045287
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0045287
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: