MEDICARE: SERGIO W. LARACH 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	208C00000X	Colon & Rectal Surgery Physician	ME25149	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	:	1790744878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO W. LARACH M.D.

Provider Business Mailing Address
First Line	:	100 N DEAN RD
Second Line	:	SUITE 101
City	:	ORLANDO
State	:	FL
Zip	:	32825-3710
Country	:	US
Telephone Number	:	407-384-7388
Fax Number	:	407-384-7391

Provider Business Practice Location Address
First Line	:	100 N DEAN RD
Second Line	:	SUITE 101
City	:	ORLANDO
State	:	FL
Zip	:	32825-3710
Country	:	US
Telephone Number	:	407-384-7388
Fax Number	:	407-384-7391

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

Provider Enumeration Date	:	03/19/2006
Last Update Date	:	02/13/2014

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