Provider Demographics
NPI:1316973852
Name:CHIDGEY, LARRY K (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:K
Last Name:CHIDGEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:KEITH
Other - Last Name:CHIDGEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-7374
Mailing Address - Fax:352-273-7388
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-7374
Practice Address - Fax:352-273-7388
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME407262086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047027900Medicaid
68444ZMedicare PIN
A29640Medicare UPIN
FL68444Medicare ID - Type Unspecified