Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 01021544A | IN |
NPI | 1649324401 |
---|---|
Provider Name | Dr. Larry Neil Monn |
First Address | Indianapolis, IN 46256-5630 |
Second Address | Indianapolis, IN 46256-5630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 06/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000083901 | ANTHEM (01) | IN |
100057220A | (05) | IN |
B28215 | (02) | IN |