Provider Demographics
NPI:1265614192
Name:STRICKLAND, LARRY LEE JR (DPM)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:LEE
Last Name:STRICKLAND
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 N I-35
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-3408
Mailing Address - Country:US
Mailing Address - Phone:940-566-3838
Mailing Address - Fax:940-382-6393
Practice Address - Street 1:4230 I35 NORTH
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207
Practice Address - Country:US
Practice Address - Phone:940-566-3838
Practice Address - Fax:940-382-6393
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1313213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018837701Medicaid
TX00U62XMedicare UPIN
TX018837701Medicaid