Provider Demographics
NPI:1396751723
Name:PLACER LARRAURI, CARLOS JOSE (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:JOSE
Last Name:PLACER LARRAURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:JOSE
Other - Last Name:PLACER LARRAURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8815 CONROY WINDERMERE RD
Mailing Address - Street 2:#203
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3129
Mailing Address - Country:US
Mailing Address - Phone:407-483-4079
Mailing Address - Fax:407-572-8642
Practice Address - Street 1:988 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1615
Practice Address - Country:US
Practice Address - Phone:407-483-4079
Practice Address - Fax:407-572-8642
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82389208100000X, 2081P2900X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
111601OtherAMERIGROUP
FL5053308OtherCIGNA
FL261952100Medicaid
331018616OtherUHC
331018616OtherTRICARE
03009OtherBCBS
FL2940027OtherAETNA
331018616OtherHUMANA
331018616OtherCIGNA
331018616OtherUHC
03009ZMedicare PIN
331018616OtherCIGNA
H44611Medicare UPIN