Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 04-30533 | KS |
NPI | 1063413151 |
---|---|
Provider Name | Dr. Larry R Corum |
First Address | Olathe, KS 66061-7218 |
Second Address | Olathe, KS 66061-7218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 18/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200266340D | (05) | KS |
34068015 | BC/BS OF KC (01) | KS |
I05488 | (02) | KS |