=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528057577
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRY FREDERICK PATRICK CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2005
-----------------------------------------------------
Last Update Date | 07/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9500 BROADWAY EXT
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73114-7425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-475-0600
-----------------------------------------------------
Fax | 405-475-0610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16505 THORTON LN
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73003-6883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-607-4824
-----------------------------------------------------
Fax | 405-607-4824
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | R0024225
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------