Provider Demographics
NPI:1013991074
Name:FELDMAN, LARRYE MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:LARRYE
Middle Name:MICHAEL
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3389 SHERIDAN ST
Mailing Address - Street 2:BOX #204
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3606
Mailing Address - Country:US
Mailing Address - Phone:954-240-0813
Mailing Address - Fax:
Practice Address - Street 1:3389 SHERIDAN ST
Practice Address - Street 2:BOX #204
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3606
Practice Address - Country:US
Practice Address - Phone:954-240-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036483500Medicaid
FLOS0003209OtherLICENSE STATE OF FLA
FLOS0003209OtherLICENSE STATE OF FLA
FL036483500Medicaid
E32109Medicare UPIN