Healthcare Provider Details

I. General information

NPI: 1114907599
Provider Name (Legal Business Name): JAMES P LAROY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 NICOLLET AVE SO
RICHFIELD MN
55423-1697
US

IV. Provider business mailing address

6440 NICOLLET AVE SO
RICHFIELD MN
55423-1697
US

V. Phone/Fax

Practice location:
  • Phone: 612-861-1622
  • Fax: 612-861-2307
Mailing address:
  • Phone: 612-861-1622
  • Fax: 612-861-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36599
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: