Healthcare Provider Details

I. General information

NPI: 1396701652
Provider Name (Legal Business Name): LARRY M YU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78MDG /SGP 655 SOUTH 7TH STREET BLDG 700/700-A
ROBINS AFB GA
31098
US

IV. Provider business mailing address

655 SOUTH 7TH STREET BLDG 700/700-A 78 MDG/SGP
ROBINS AFB GA
31098
US

V. Phone/Fax

Practice location:
  • Phone: 478-327-8487
  • Fax:
Mailing address:
  • Phone: 478-327-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number8764
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number8764
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number8764
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: