Provider Demographics
NPI:1619077419
Name:SAUNDERS, LARRY HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:HOWARD
Last Name:SAUNDERS
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 1:3030 N ROCKY POINT DR W
Mailing Address - Street 2:STE 670
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5803
Mailing Address - Country:US
Mailing Address - Phone:239-597-0196
Mailing Address - Fax:239-597-5628
Practice Address - Street 1:3030 N ROCKY POINT DR W
Practice Address - Street 2:STE 670
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5803
Practice Address - Country:US
Practice Address - Phone:239-597-0196
Practice Address - Fax:239-597-5628
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42237207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36358OtherBLUE CROSS OF FLORIDA
FL069910100Medicaid
FL36358WMedicare PIN
FL36358VMedicare PIN
930122030Medicare PIN
FL36358OtherBLUE CROSS OF FLORIDA
P00266753Medicare PIN
FL36358PMedicare PIN
FLD54487Medicare UPIN