Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0421046 | KS |
N | 207RG0300X | Geriatric Medicine | 0421046 | KS |
N | 2080A0000X | Adolescent Medicine | 0421046 | KS |
NPI | 1184690695 |
---|---|
Provider Name | Mr. James Ray Larzalere |
First Address | Mcpherson, KS 67460 |
Second Address | Mcpherson, KS 67460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B91270 | (02) |