Individual
LARRY LEYDERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
13933 17TH ST STE 200, DADE CITY, FL 33525-4604
(352) 437-5972
(352) 437-5974
Mailing address
1324 LAKELAND HILLS BLVD, ATTN: MANAGED CARE DEPT, LAKELAND, FL 33805-4543
(863) 687-1100
(863) 630-6528
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9114483
FL
363AS0400X
Surgical Physician Assistant
085004191
IL
363AS0400X
Surgical Physician Assistant
Primary
PA9114483
FL
Other
Enumeration date
11/25/2011
Last updated
12/01/2025
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