1043625411 NPI number — MR. LARRY CHERRY JR.

Table of content: MR. LARRY CHERRY JR. (NPI 1043625411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043625411 NPI number — MR. LARRY CHERRY JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHERRY
Provider First Name:
LARRY
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043625411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2948 ANTIQUE OAKS CIR
Provider Second Line Business Mailing Address:
UNIT 92
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-5656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-205-7310
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1434 MARVIN C ZANDERS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APOPKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32703-7070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-485-3484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)