MEDICARE: DR. LARRY TATE MCGARY DDS

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	1223G0001X	General Practice Dentistry	KS6031	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	421736	OTHER	KS	BLUE CROSS BLUE SHIELD
2	733311	OTHER	KS	UNITED CONCORDIA TRICARE

General Provider Information

NPI Number	:	1174632236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY TATE MCGARY DDS

Provider Business Mailing Address
First Line	:	PO BOX 1085
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-1085
Country	:	US
Telephone Number	:	785-238-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 W 6TH ST
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-3228
Country	:	US
Telephone Number	:	785-238-3500
Fax Number	:	785-238-8323

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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