MEDICARE: DR. LARRY PUTHENPARAMBIL 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	207WX0107X	Retina Specialist (Ophthalmology) Physician	P2345	TX
2	207W00000X	Ophthalmology Physician	P2345	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	:	1679718506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY PUTHENPARAMBIL MD

Provider Business Mailing Address
First Line	:	8540 BROADWAY ST STE 210
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7710
Country	:	US
Telephone Number	:	832-727-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	8540 BROADWAY ST STE 210
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7710
Country	:	US
Telephone Number	:	832-727-1771
Fax Number	:

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

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	07/27/2023

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