Provider Demographics
NPI:1497741839
Name:DEEB, LARRY CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:CHARLES
Last Name:DEEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:C
Other - Last Name:DEEB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,PA
Mailing Address - Street 1:2633 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-0585
Mailing Address - Country:US
Mailing Address - Phone:850-877-7387
Mailing Address - Fax:850-656-3376
Practice Address - Street 1:2633 CENTENNIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0606
Practice Address - Country:US
Practice Address - Phone:850-431-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 364052080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00241018CMedicaid
FL039439400Medicaid
FL37276OtherBLUECROSS BLUE SHIELD
GA00241018CMedicaid