MEDICARE: RICARDO JOSE LARRAIN MD

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	207V00000X	Obstetrics & Gynecology Physician	ME0062589	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	:	1154483634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO JOSE LARRAIN MD

Provider Business Mailing Address
First Line	:	800 W PLYMOUTH AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3271
Country	:	US
Telephone Number	:	386-736-1404
Fax Number	:	386-736-1423

Provider Business Practice Location Address
First Line	:	800 W PLYMOUTH AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3271
Country	:	US
Telephone Number	:	386-736-1404
Fax Number	:	386-736-1423

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	06/19/2012

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