MEDICARE: LARRY D ROPER

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1447593512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY D ROPER

Provider Business Mailing Address
First Line	:	2508 YORKSHIRE ST
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75061-6758
Country	:	US
Telephone Number	:	214-923-7503
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 YORKSHIRE ST
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75061-6758
Country	:	US
Telephone Number	:	214-923-7503
Fax Number	:

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

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	03/27/2013

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Directions to “ LARRY D ROPER ” Practice Location

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