Provider Demographics
NPI:1356490619
Name:LARRY C. DEEB, M.D., P.A.
Entity type:Organization
Organization Name:LARRY C. DEEB, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-878-0184
Mailing Address - Street 1:2804 REMINGTON GREEN CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1550
Mailing Address - Country:US
Mailing Address - Phone:850-878-0184
Mailing Address - Fax:850-216-1537
Practice Address - Street 1:2804 REMINGTON GREEN CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-1550
Practice Address - Country:US
Practice Address - Phone:850-878-0184
Practice Address - Fax:850-216-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00364052080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP23LJOtherFLORIDA BLUE
FL039439400Medicaid
GA000241018AMedicaid
GA000241018AMedicaid