Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | OS9817 | FL |
NPI | 1043263924 |
---|---|
Provider Name | Dr. Lara J Fix |
First Address | Stuart, FL 34995-1637 |
Second Address | Stuart, FL 34994-2428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 19/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
276995600 | (05) | FL |
4995388 | CIGNA (01) | FL |