Larry Gideon, M D

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

LG407549 Issued in MI

Legal business name

LARRY GIDEON, M D

Practice address

609 Bunnell M 19
Memphis, MI 48041

Phone

(810) 392-2192

NPI assigned

Jun 1, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Larry Gideon, M D

Title

President

Phone

(810) 392-2192

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255533386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 BUNNELL M 19",
            "city": "MEMPHIS",
            "state": "MI",
            "postal_code": "48041",
            "telephone_number": "810-392-2192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 BUNNELL M 19",
            "city": "MEMPHIS",
            "state": "MI",
            "postal_code": "48041",
            "telephone_number": "810-392-2192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY GIDEON, M D",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GIDEON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-392-2192",
        "authorized_official_credential": "M D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "LG407549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCE",
            "identifier": "LG407549",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Dunsmore, PA-C
• Fortis One Counseling, L.L.C.
• Mary Ann Golish, B A
• Nicola Iosif Jaksa, DC
• Pamela Jones
• Lois Macdonald, RN
• Michael John Maniscalco, MA, LLPC, CACLL
• Nancy Carole Mills, M.A., CAC-I
• Cindy Lee Nash, RN
• Sacred Heart

• Family Medicine Physician in Memphis, MI
• Providers in Memphis, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.