Provider Demographics
NPI:1114918174
Name:LARKIN, STEPHEN GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GRANT
Last Name:LARKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6092 PARK RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6092 PARK RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4627
Practice Address - Country:US
Practice Address - Phone:239-267-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033554E207P00000X, 207Q00000X
FLME46483207P00000X
FLME0046483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143565OtherBLUECROSSBLUESHIELD
FL272385900Medicaid
FL04306OtherBLUE CROSSBLUE SHIELD
PA219102OtherUPMC
PA00010066900002Medicaid
PA143565Medicare ID - Type Unspecified
FL04306RMedicare PIN
FL272385900Medicaid
FLP00411094Medicare PIN