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NPI Code Detail

MEDICARE: DR. LARRY K CRUEL DPM

MEDICARE: DR. LARRY K CRUEL DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213EP1101XPrimary Podiatric Medicine Podiatrist80152MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609996982
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY K CRUEL DPM
Provider Business Mailing Address
First Line : 4510 OFFICE PARK DR
Second Line :
City : JACKSON
State : MS
Zip : 39206-6016
Country : US
Telephone Number : 601-981-3001
Fax Number : 601-981-8999
Provider Business Practice Location Address
First Line : 4510 OFFICE PARK DR
Second Line :
City : JACKSON
State : MS
Zip : 39206-6016
Country : US
Telephone Number : 601-981-3001
Fax Number : 601-981-8999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 06/30/2008

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Directions to “ DR. LARRY K CRUEL DPM” Practice Location

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