Basic Information
| Provider Information | |||||||||
| NPI: | 1245210046 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAROSE | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18868 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325238868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509945660 | ||||||||
| FaxNumber: | 8509945841 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 BRENT LN | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504712221 | ||||||||
| FaxNumber: | 8504712232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 02/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME 40352 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | Z113 | 01 | FL | VISTA | OTHER | 067040500 | 05 | FL | MEDICAID | Z113 | 01 | FL | HEALTHEASE | OTHER | 434705599 | 01 | FL | TRICARE | OTHER | Z113 | 01 | FL | HEALTHY KIDS | OTHER | Z113 | 01 | FL | HEALTH OPTIONS | OTHER | 160055559 | 01 | FL | RAILROAD MEDICARE | OTHER | Z113 | 01 | FL | WELLCARE | OTHER | 59167048 | 01 | AL | BLUE CROSS BLUE SHIELD AL | OTHER | 17523 | 01 | FL | BLUE CROSS BLUE SHIELD FL | OTHER |