MEDICARE: LARRY DALE WHITCOMB MD

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	208600000X	Surgery Physician	F5798	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225063233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY DALE WHITCOMB MD

Provider Business Mailing Address
First Line	:	PO BOX 540040
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-0040
Country	:	US
Telephone Number	:	972-988-1006
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 4TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79430-8312
Country	:	US
Telephone Number	:	806-778-4457
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/07/2013

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Directions to “ LARRY DALE WHITCOMB MD” Practice Location

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