Healthcare Provider Details

I. General information

NPI: 1821051624
Provider Name (Legal Business Name): LARRY D CANTEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 US HIGHWAY 321 BYP N
WINNSBORO SC
29180-9251
US

IV. Provider business mailing address

102 US HIGHWAY 321 BYP N
WINNSBORO SC
29180-9251
US

V. Phone/Fax

Practice location:
  • Phone: 803-712-0373
  • Fax: 803-635-1760
Mailing address:
  • Phone: 803-712-0373
  • Fax: 803-635-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number9809
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: