Provider Demographics
NPI:1902841406
Name:PADGETT, LARRY R JR (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:R
Last Name:PADGETT
Suffix:JR
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 1:250 3RD ST NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4605
Mailing Address - Country:US
Mailing Address - Phone:863-318-9696
Mailing Address - Fax:863-318-8075
Practice Address - Street 1:250 3RD ST NW
Practice Address - Street 2:SUITE 201
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4605
Practice Address - Country:US
Practice Address - Phone:863-318-9696
Practice Address - Fax:863-318-8075
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF59694Medicare UPIN