Provider Demographics
NPI:1770699738
Name:KIPP, LARRY J (DPM)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:KIPP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7211 N DALE MABRY HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2669
Mailing Address - Country:US
Mailing Address - Phone:727-847-2406
Mailing Address - Fax:727-841-0567
Practice Address - Street 1:5145 DEER PARK DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-7013
Practice Address - Country:US
Practice Address - Phone:727-847-2406
Practice Address - Fax:855-552-3776
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLP0000655213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00414977OtherRAILROAD MEDICARE
FL33537Medicare PIN
FL0658830003Medicare NSC
FL87340Medicare PIN
FL87340WMedicare PIN
FL0477670001Medicare NSC
FLP00414977OtherRAILROAD MEDICARE