Individual
LARRY HUGH FORMBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
19043
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00139004A
—
GA
Enumeration date
09/01/2005
Last updated
11/23/2009
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