Provider Demographics
NPI:1700034345
Name:SMITH, LARRY NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:NELSON
Last Name:SMITH
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 1:10925 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8937
Mailing Address - Country:US
Mailing Address - Phone:352-332-5626
Mailing Address - Fax:352-332-5759
Practice Address - Street 1:10925 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8937
Practice Address - Country:US
Practice Address - Phone:352-332-5626
Practice Address - Fax:352-332-5759
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 49162207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery