Provider Demographics
NPI:1982081683
Name:LAROCQUE, RAYMOND TIMOTHY (MD)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:TIMOTHY
Last Name:LAROCQUE
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 1:584 NW UNIVERSITY BLVD STE 370
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2268
Mailing Address - Country:US
Mailing Address - Phone:586-252-0069
Mailing Address - Fax:
Practice Address - Street 1:1700 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4803
Practice Address - Country:US
Practice Address - Phone:586-252-0069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2025-01-27
Deactivation Date:2015-12-09
Deactivation Code:
Reactivation Date:2015-12-31
Provider Licenses
StateLicense IDTaxonomies
CODR.0060701207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine