Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | ME 36405 | FL |
NPI | 1497741839 |
---|---|
Provider Name | Larry Charles Deeb |
First Address | Tallahassee, FL 32309-0585 |
Second Address | Tallahassee, FL 32308-0606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 13/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00241018C | (05) | GA |
039439400 | (05) | FL |
37276 | BLUECROSS BLUE SHIELD (01) | FL |
D54606 | (02) | FL |