Provider Demographics
NPI:1033104062
Name:SUECOF, LARRY ALAN (DPM)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ALAN
Last Name:SUECOF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 MCCRORY PL STE 174
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3727
Mailing Address - Country:US
Mailing Address - Phone:407-219-5402
Mailing Address - Fax:407-517-1040
Practice Address - Street 1:202 N PARK AVE STE 500
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703
Practice Address - Country:US
Practice Address - Phone:407-410-1234
Practice Address - Fax:407-517-1040
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000281213E00000X, 213EP1101X, 213ER0200X, 213ES0103X
FLPOOOO2293213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1406459OtherCORVEL
CT06-1406459OtherHMC, PPO
CT06-1406459OtherFOCUS
CT06-1406459OtherGREAT WEST HEALTHCARE
CT06-1406459OtherUNITED HEALTHCARE
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEM
CT2534362OtherAETNA
CT004006805Medicaid
CT06-1406459OtherCOLONIAL COOPERATIVE CARE
CT060021OtherCONNECTICARE
CT0600211278OtherCONNECTICARE
480000668OtherMEDICARE
CT0R3020OtherHEALTH NET
CT1033104062OtherANTHEM BCBS
MA0358436Medicaid
CT06-1406459OtherMULTIPLAN
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT0724234 001OtherCIGNA
CTP4041219OtherOXFORD
CT06-1406459OtherGREAT WEST HEALTHCARE
CT1033104062OtherANTHEM BCBS