Provider Demographics
NPI:1760736763
Name:LARRY D RABON MD PA
Entity Type:Organization
Organization Name:LARRY D RABON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RABON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-665-2200
Mailing Address - Street 1:306 S MCQUEEN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4723
Mailing Address - Country:US
Mailing Address - Phone:843-665-2200
Mailing Address - Fax:843-665-2210
Practice Address - Street 1:306 S MCQUEEN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4723
Practice Address - Country:US
Practice Address - Phone:843-665-2200
Practice Address - Fax:843-665-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC05395302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization