Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 000315 | MO |
NPI | 1083656391 |
---|---|
Provider Name | Dr. Larry Randolph Narup |
First Address | Brentwood, MO 63144-2604 |
Second Address | Brentwood, MO 63144-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 31/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T42841 | (02) | MO |