Provider Demographics
NPI:1912920950
Name:LARUE, TODD (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:LARUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQUARE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:13417 US HWY 301 S
Practice Address - Street 2:SUITE D
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525
Practice Address - Country:US
Practice Address - Phone:352-567-8640
Practice Address - Fax:813-355-5027
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063260100Medicaid
FL080044518OtherRR MEDICARE
FLP00967820OtherRR MEDICARE - UCC
FLP00967820OtherRR MEDICARE - UCC
FL10164W - UCCMedicare PIN
FL080044518OtherRR MEDICARE