Provider Demographics
NPI:1346298916
Name:POPEIL, LARRY R (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:R
Last Name:POPEIL
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 1:2203 SE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5117
Mailing Address - Country:US
Mailing Address - Phone:352-622-2477
Mailing Address - Fax:
Practice Address - Street 1:2203 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5117
Practice Address - Country:US
Practice Address - Phone:352-622-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 44562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080080501OtherRAILROAD MEDICARE
FL068936000Medicaid
FL20063OtherBC/BS
593024305OtherTAX ID NUMBER
593024305OtherTAX ID NUMBER
080080501OtherRAILROAD MEDICARE