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General NPI Number Information
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NPI Number | 1114918174
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Entity Type | Individual
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Provider Name | STEPHEN GRANT LARKIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 6092 PARK RD
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City | FORT MYERS
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State | FL
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Zip | 33908-4627
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Country | US
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Telephone | 239-267-2521
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Fax |
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Provider Business Mailing Address
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Address Line | 6092 PARK RD
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City | FORT MYERS
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State | FL
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Zip | 33908-4627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD033554E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME46483
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD033554E
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0046483
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License Number State | FL
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