Provider Demographics
NPI:1528222528
Name:MACKALL, LARRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:L
Last Name:MACKALL
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 1:605 UNITED ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3229
Mailing Address - Country:US
Mailing Address - Phone:305-393-1138
Mailing Address - Fax:305-293-4684
Practice Address - Street 1:605 UNITED ST
Practice Address - Street 2:SUITE B
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3229
Practice Address - Country:US
Practice Address - Phone:305-393-1138
Practice Address - Fax:305-293-4684
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50055207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology