Provider Demographics
NPI:1750392957
Name:ERLINDER, LARRY ELDRIDGE (DPM)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:ELDRIDGE
Last Name:ERLINDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 SANTA BARBARA BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6820
Mailing Address - Country:US
Mailing Address - Phone:352-259-1919
Mailing Address - Fax:352-259-2042
Practice Address - Street 1:1585 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6820
Practice Address - Country:US
Practice Address - Phone:352-259-1919
Practice Address - Fax:352-259-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003011213E00000X
FLPO 3501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
60001061OtherBLUE CROSS/BLUE SHIELD ID
T36970Medicare UPIN
480003345Medicare ID - Type UnspecifiedPALMETTO (RR MEDICARE) ID
522330Medicare ID - Type UnspecifiedMEDICARE ID