Healthcare Provider Details

I. General information

NPI: 1497741839
Provider Name (Legal Business Name): LARRY CHARLES DEEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LARRY C. DEEB M.D.,P.A.

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 CENTENNIAL BLVD STE 100
TALLAHASSEE FL
32308-0606
US

IV. Provider business mailing address

2633 CENTENNIAL BLVD SUITE 100
TALLAHASSEE FL
32309-0585
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5404
  • Fax:
Mailing address:
  • Phone: 850-877-7387
  • Fax: 850-656-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME 36405
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: