Provider Demographics
NPI:1548517592
Name:AMES, LARRY J
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:J
Last Name:AMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8480 SW 140TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1040
Mailing Address - Country:US
Mailing Address - Phone:305-298-1355
Mailing Address - Fax:786-242-3598
Practice Address - Street 1:8480 SW 140TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33158-1040
Practice Address - Country:US
Practice Address - Phone:305-298-1355
Practice Address - Fax:786-242-3598
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBC1256251171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL171WH0202XOtherTAXONOMY CODES