Healthcare Provider Details

I. General information

NPI: 1023057270
Provider Name (Legal Business Name): JOSEPH A LARAKERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S HILLSIDE DR
BEEVILLE TX
78102-5333
US

IV. Provider business mailing address

PO BOX 4543
BEEVILLE TX
78104-4543
US

V. Phone/Fax

Practice location:
  • Phone: 361-358-2392
  • Fax: 361-358-7640
Mailing address:
  • Phone: 361-358-2392
  • Fax: 361-358-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ8633
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: