Healthcare Provider Details

I. General information

NPI: 1437144375
Provider Name (Legal Business Name): LARRY R HANDLIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W JEFFERSON ST
KIRKSVILLE MO
63501-1443
US

IV. Provider business mailing address

201 E MONROE ST
MEXICO MO
65265-2852
US

V. Phone/Fax

Practice location:
  • Phone: 660-785-1991
  • Fax: 660-785-1989
Mailing address:
  • Phone: 573-581-3240
  • Fax: 573-581-7493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR4H76
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: