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General NPI Number Information
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NPI Number | 1427409929
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Entity Type | Organization
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Legal Business Name | LARRY FOREMAN, DO
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 345 S HALCYON RD
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3817
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Country | US
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Telephone | 805-459-8917
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Fax |
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Provider Business Mailing Address
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Address Line | 1945 CORBETT HIGHLANDS PL
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-4933
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Country | US
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Telephone | 805-459-8917
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | LARRY W FOREMAN
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Credential | DO
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Telephone | 805-459-8917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Emergency Medicine) Physician
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License Number | 20A5055
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License Number State | CA
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