Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01043526A | IN |
N | 111NI0900X | Internist | 01043526A | IN |
N | 207RH0002X | Hospice and Palliative Medicine | 01043526A | IN |
N | 207RH0003X | Hematology & Oncology | 01043526 | IN |
Y | 207RH0003X | Hematology & Oncology | 01043526A | IN |
NPI | 1225094741 |
---|---|
Provider Name | Larry D Cripe |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200024940 | (05) | IN |
E45556 | (02) | IN |