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General NPI Number Information
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NPI Number | 1760705925
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Entity Type | Organization
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Legal Business Name | LARRY DEFFENBAUGH, DO,PC
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 1905 W. 32ND ST. SUITE 302
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City | JOPLIN
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State | MO
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Zip | 64804
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Country | US
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Telephone | 417-782-4701
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Fax | 417-624-5881
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Provider Business Mailing Address
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Address Line | 1905 W. 32ND ST. SUITE 302
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City | JOPLIN
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State | MO
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Zip | 64804
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Country | US
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Telephone | 417-782-4701
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Fax | 417-624-5881
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY D DEFFENBAUGH
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Credential | DO
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Telephone | 417-782-4701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | R6321
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License Number State | MO
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