Provider Demographics
NPI:1811947302
Name:LARRY R BACHLE DO FACOEP PA
Entity type:Organization
Organization Name:LARRY R BACHLE DO FACOEP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BACHLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO FACOEP
Authorized Official - Phone:941-764-9560
Mailing Address - Street 1:PO BOX 510669
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0669
Mailing Address - Country:US
Mailing Address - Phone:941-764-9560
Mailing Address - Fax:941-205-2630
Practice Address - Street 1:25097 OLYMPIA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3903
Practice Address - Country:US
Practice Address - Phone:941-205-2620
Practice Address - Fax:941-205-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6291207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37095230Medicaid
FLP00316034OtherRR MEDICARE
FLDE7887OtherRR MEDICARE GRP #
FLK9790Medicare PIN
FLE35257Medicare UPIN