MEDICARE: DR. RICHARD ELLIS LAREW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	27484	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49886	OTHER	IA	WELLMARK BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003880592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ELLIS LAREW M.D.

Provider Business Mailing Address
First Line	:	2557 N DODGE ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-9556
Country	:	US
Telephone Number	:	319-338-1535
Fax Number	:	319-338-5768

Provider Business Practice Location Address
First Line	:	2460 TOWNCREST DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-6622
Country	:	US
Telephone Number	:	319-338-7862
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	03/07/2023

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