Organization
MICHAEL DAVID LARA, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DAVID LARA M.D. (PRESIDENT/ OWNER)
(915) 383-6679
Entity
Organization
Contact information
Practice address
10175 GATEWAY BLVD W, 220, EL PASO, TX 79925-7618
(915) 383-6679
Mailing address
1655 MOSSWOOD ST, EL PASO, TX 79935-3435
(915) 383-6679
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
L8406
TX
Other
Enumeration date
03/23/2016
Last updated
05/11/2016
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