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General NPI Number Information
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NPI Number | 1518058163
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Entity Type | Individual
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Provider Name | LARRY P EBBERT MD
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/16/2025
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Provider Practice Location Address
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Address Line | 85 MAUI LANI PKWY
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City | WAILUKU
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State | HI
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Zip | 96793-2416
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Country | US
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Telephone | 808-442-5700
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Fax | 808-442-5652
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Provider Business Mailing Address
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Address Line | 6603 ELK CREEK RD
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City | PIEDMONT
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State | SD
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Zip | 57769-2032
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Country | US
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Telephone | 605-484-1176
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Fax |
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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 | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 2083
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MC-274
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License Number State | GU
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Taxonomy #3
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 74117
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License Number State | SD
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD-21014
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License Number State | HI
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