Provider Demographics
NPI:1992953186
Name:LARRY J. KIPP DPM PA
Entity type:Organization
Organization Name:LARRY J. KIPP DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-868-2128
Mailing Address - Street 1:7117 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6708
Mailing Address - Country:US
Mailing Address - Phone:727-868-2128
Mailing Address - Fax:727-868-7491
Practice Address - Street 1:8101 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3000
Practice Address - Country:US
Practice Address - Phone:727-868-2128
Practice Address - Fax:727-868-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP0000655213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT95143Medicare UPIN
FL0658830004Medicare NSC
FL87340AMedicare PIN