Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME30624 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME30624 | FL |
NPI | 1053420117 |
---|---|
Provider Name | Larry Don Garland |
First Address | Maitland, FL 32751-7235 |
Second Address | Boca Raton, FL 33496-2659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 09/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D63835 | (02) | FL |