Provider Demographics
NPI:1821254277
Name:LARRY L MACKALL MD LLC
Entity Type:Organization
Organization Name:LARRY L MACKALL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACKALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-296-0400
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:305-296-0400
Mailing Address - Fax:305-293-4683
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:305-296-0400
Practice Address - Fax:305-293-4683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50055207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty