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General NPI Number Information
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NPI Number | 1275540411
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Entity Type | Individual
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Provider Name | LARRY LORENZO MCCULLOUGH M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 540 W 15TH ST
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City | HEREFORD
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State | TX
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Zip | 79045-2820
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Country | US
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Telephone | 806-364-7512
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Fax | 806-364-5256
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-465-7042
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Fax | 615-628-6877
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VC0300X
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Taxonomy Name | Complex Family Planning Physician
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License Number | S8207
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD057040L
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License Number State | PA
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