Provider Demographics
NPI:1922100106
Name:LARRAURI, JUAN MANUEL (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:LARRAURI
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 1:3414 DUCK AVE UNIT 10
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4495
Mailing Address - Country:US
Mailing Address - Phone:305-741-7707
Mailing Address - Fax:339-023-6158
Practice Address - Street 1:3414 DUCK AVE UNIT 10
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4495
Practice Address - Country:US
Practice Address - Phone:057-417-7073
Practice Address - Fax:339-023-6158
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51573208600000X
FLME0051573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09794OtherINDIVIDUAL PROVIDER NUMBE
FL062142100Medicaid
FLKO536Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL062142100Medicaid