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General NPI Number Information
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NPI Number | 1609996982
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Entity Type | Individual
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Provider Name | LARRY K CRUEL DPM
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 4510 OFFICE PARK DR
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City | JACKSON
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State | MS
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Zip | 39206-6016
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Country | US
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Telephone | 601-981-3001
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Fax | 601-981-8999
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Provider Business Mailing Address
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Address Line | 4510 OFFICE PARK DR
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City | JACKSON
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State | MS
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Zip | 39206-6016
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Country | US
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Telephone | 601-981-3001
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Fax | 601-981-8999
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 80152
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License Number State | MS
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