MEDICARE: DR. LARRY WILLIAM FIELD DO, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS0005612	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80467	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1770575904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY WILLIAM FIELD DO, MBA

Provider Business Mailing Address
First Line	:	3101 SW 34TH AVE
Second Line	:	#905-454
City	:	OCALA
State	:	FL
Zip	:	34474-7447
Country	:	US
Telephone Number	:	352-895-9546
Fax Number	:	815-352-1571

Provider Business Practice Location Address
First Line	:	3101 SW 34TH AVE
Second Line	:	#905-454
City	:	OCALA
State	:	FL
Zip	:	34474-7447
Country	:	US
Telephone Number	:	352-895-9546
Fax Number	:	815-352-1571

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/16/2010

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