MEDICARE: DR. LARRY LEN MAPLES DO

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	207P00000X	Emergency Medicine Physician	J0090	TX
2	207Q00000X	Family Medicine Physician	J0090	TX

General Provider Information

NPI Number	:	1033166616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY LEN MAPLES DO

Provider Business Mailing Address
First Line	:	101 S HARTFORD ST
Second Line	:
City	:	BRECKENRIDGE
State	:	TX
Zip	:	76424-4711
Country	:	US
Telephone Number	:	254-559-3363
Fax Number	:	254-559-2572

Provider Business Practice Location Address
First Line	:	101 S HARTFORD ST
Second Line	:
City	:	BRECKENRIDGE
State	:	TX
Zip	:	76424-4711
Country	:	US
Telephone Number	:	254-559-3363
Fax Number	:	254-559-2572

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	02/03/2016

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