MEDICARE: DR. LARRY A. BOOKMAN M.D.

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
1	207RG0100X	Gastroenterology Physician	11864	OK
2	207RG0100X	Gastroenterology Physician	G43065	CA

General Provider Information

NPI Number	:	1689658882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY A. BOOKMAN M.D.

Provider Business Mailing Address
First Line	:	8121 NATIONAL AVE
Second Line	:	STE 303
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7530
Country	:	US
Telephone Number	:	405-737-4464
Fax Number	:	405-737-7674

Provider Business Practice Location Address
First Line	:	8121 NATIONAL AVE
Second Line	:	STE 303
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7530
Country	:	US
Telephone Number	:	405-737-4464
Fax Number	:	405-737-7674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	08/10/2011

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