Provider Demographics
NPI:1942735626
Name:HEARD, LARRY KEVIN
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:KEVIN
Last Name:HEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 THONOTOSASSA RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-2941
Mailing Address - Country:US
Mailing Address - Phone:813-752-0757
Mailing Address - Fax:
Practice Address - Street 1:2010 THONOTOSASSA RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2941
Practice Address - Country:US
Practice Address - Phone:813-752-0757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME147922207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program