MEDICARE: PAUL E LAROSE M.D.

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	ME 40352	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	160055559	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z113	OTHER	FL	VISTA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	Z113	OTHER	FL	HEALTHEASE
4	434705599	OTHER	FL	TRICARE
5	Z113	OTHER	FL	HEALTHY KIDS
6	Z113	OTHER	FL	HEALTH OPTIONS
8	Z113	OTHER	FL	WELLCARE
9	59167048	OTHER	AL	BLUE CROSS BLUE SHIELD AL
10	17523	OTHER	FL	BLUE CROSS BLUE SHIELD FL
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245210046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL E LAROSE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 18868
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32523-8868
Country	:	US
Telephone Number	:	850-994-5660
Fax Number	:	850-994-5841

Provider Business Practice Location Address
First Line	:	525 BRENT LN
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2003
Country	:	US
Telephone Number	:	850-471-2221
Fax Number	:	850-471-2232

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	02/03/2010

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Directions to “ PAUL E LAROSE M.D.” Practice Location

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