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NPI Code Detail

MEDICARE: CONNOR LAROSE M.D.

MEDICARE:   CONNOR  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
1390200000XStudent in an Organized Health Care Education/Training ProgramAD3189380-CL19NC
2207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianA111430CA

General Provider Information

NPI Number : 1659538486
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNOR LAROSE M.D.
Provider Business Mailing Address
First Line : 2301 ERWIN RD
Second Line :
City : DURHAM
State : NC
Zip : 27710-0001
Country : US
Telephone Number : 919-970-7363
Fax Number :
Provider Business Practice Location Address
First Line : 1901 W LUGONIA AVE
Second Line : SUITE 230
City : REDLANDS
State : CA
Zip : 92374-9703
Country : US
Telephone Number : 909-557-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2008
Last Update Date : 03/14/2012

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