| Doctor Name: | DR. ETHELBERT M LARA |
| NPI Number: | 1437232022 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 4301039413 |
| Business Practice Address: | 205 Osceola St Laurium, MI - 499132134 |
| Business Phone Number: | 9062250122 |
| Business Fax Number: | 9062250135 |
| Mailing Address: | 710 Chippewa Sq, Suite 101 MARQUETTE |
| State: | MI |
| Postal Code: | 498554821 |
| Phone Number: | 9062250122 |
| Fax Number: | 9062250135 |
| NPI Enumeration Date: | 10/24/2006 |
| NPI Last Update Date: | 08/11/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 4301039413 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |