Provider Demographics
NPI:1477559060
Name:FOSTER, LARRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6014
Mailing Address - Country:US
Mailing Address - Phone:352-787-1324
Mailing Address - Fax:
Practice Address - Street 1:802 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6014
Practice Address - Country:US
Practice Address - Phone:352-787-1324
Practice Address - Fax:352-365-1003
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
695956OtherTUFTS
FL02926OtherBCBS
593516436003OtherTRICARE
P00397535OtherRR GBA MEDICARE
773114OtherMAILHANDLERS
593516436OtherMEDICAL MUTUAL
7194953OtherMAMSI
FLD84749Medicare UPIN
FL02926OtherBCBS