Healthcare Provider Details

I. General information

NPI: 1972689230
Provider Name (Legal Business Name): LARRY R NARUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8816 W PENDLETON AVE
BRENTWOOD MO
63144-2604
US

IV. Provider business mailing address

8816 W PENDLETON AVE
BRENTWOOD MO
63144-2604
US

V. Phone/Fax

Practice location:
  • Phone: 314-962-1797
  • Fax: 314-962-0656
Mailing address:
  • Phone: 314-962-1797
  • Fax: 314-962-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000315
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000315
License Number StateMO

VIII. Authorized Official

Name: DR. LARRY R NARUP
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 314-962-1797