Provider Demographics
NPI:1477826782
Name:LARRY R. POPEIL, MD, PA
Entity Type:Organization
Organization Name:LARRY R. POPEIL, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SORRENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-622-7554
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:352-622-5417
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:352-622-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44562208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068936000Medicaid
FL080080501OtherRAILROAD MEDICARE
FL20063OtherBC/BS
FL068936000Medicaid
FL20063OtherBC/BS
FL080080501OtherRAILROAD MEDICARE