Provider Demographics
NPI:1881664308
Name:LLOYD, LARRY PHILLIP II (MMSC, PA-C)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:PHILLIP
Last Name:LLOYD
Suffix:II
Gender:M
Credentials:MMSC, PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:125 CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4335
Mailing Address - Country:US
Mailing Address - Phone:919-775-1115
Mailing Address - Fax:919-775-1113
Practice Address - Street 1:125 CHATHAM ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4335
Practice Address - Country:US
Practice Address - Phone:919-775-1115
Practice Address - Fax:919-775-1113
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102462363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS64933Medicare UPIN