Healthcare Provider Details

I. General information

NPI: 1801865498
Provider Name (Legal Business Name): LARRY NEWELL AYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR STE 360
LA MESA CA
91942-3020
US

IV. Provider business mailing address

5565 GROSSMONT CENTER DR STE 360
LA MESA CA
91942-3020
US

V. Phone/Fax

Practice location:
  • Phone: 619-462-3360
  • Fax: 619-462-3363
Mailing address:
  • Phone: 619-462-3360
  • Fax: 619-462-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC28720
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC28720
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberC28720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: