Healthcare Provider Details

I. General information

NPI: 1053420117
Provider Name (Legal Business Name): LARRY DON GARLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CLINT MOORE RD STE 103
BOCA RATON FL
33496-2659
US

IV. Provider business mailing address

2600 LAKE LUCIEN DR STE 180
MAITLAND FL
32751-7235
US

V. Phone/Fax

Practice location:
  • Phone: 561-241-9667
  • Fax: 561-241-4474
Mailing address:
  • Phone: 407-875-2080
  • Fax: 407-875-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME30624
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME30624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: