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NPI Code Detail

MEDICARE: DR. LARRY DEAN KOBRIGER MD

MEDICARE: DR. LARRY DEAN KOBRIGER 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
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician37414MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15T132KOOTHERMNBCBS
2HP10785OTHERMNHEALTHPARTNERS

General Provider Information

NPI Number : 1588653331
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY DEAN KOBRIGER MD
Provider Business Mailing Address
First Line : 1027 WASHINGTON AVE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-3409
Country : US
Telephone Number : 218-847-5611
Fax Number : 218-847-0891
Provider Business Practice Location Address
First Line : 1027 WASHINGTON AVE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-3409
Country : US
Telephone Number : 218-847-5611
Fax Number : 218-847-0891
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 07/08/2007

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