Provider Demographics
NPI:1538294244
Name:SCHUTZ, LARRY E (PHD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:SCHUTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6703 CACTUS CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4501
Mailing Address - Country:US
Mailing Address - Phone:407-351-4962
Mailing Address - Fax:
Practice Address - Street 1:6001 VINELAND RD
Practice Address - Street 2:SUITE 116
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7829
Practice Address - Country:US
Practice Address - Phone:407-351-4962
Practice Address - Fax:407-345-9765
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
119589545989OtherHUMANA PROVIDER NUMBER000
2256896OtherAETNA PROVIDER NUMBER
9389583OtherPHCS PROVIDER NUMBER
FL75828Medicare PIN