Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6250 | NC |
NPI | 1023005923 |
---|---|
Provider Name | Dr. Larry Paul Parworth |
First Address | Travis Afb, CA 94535-1231 |
Second Address | Travis Afb, CA 94535-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 08/07/2007 |