Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3356 | AZ |
Y | 207Q00000X | Family Doctor | 3356 | AZ |
NPI | 1033215611 |
---|---|
Provider Name | Mr. Larry Joe Voelker |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Cave Creek, AZ 85331-5833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 23/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103001 | PACIFICARE (01) | AZ |
1Z7408 | (02) | AZ |
2370432 | AETNA (01) | AZ |
520694 | (05) | AZ |
8590128001 | CIGNA (01) | AZ |
AZ0875880 | BCBS (01) | AZ |
H22931 | (02) | AZ |