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NPI Code Detail

MEDICARE: LARRY MATHIAS III D.O.

MEDICARE: LARRY MATHIAS III D.O.
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
12085R0202XDiagnostic Radiology PhysicianOS21928FL
22085R0202XDiagnostic Radiology Physician22158ND
32085R0202XDiagnostic Radiology Physician7571OK
4207R00000XInternal Medicine Physician651497TX
52085R0204XVascular & Interventional Radiology Physician7571OK
62085R0202XDiagnostic Radiology Physician651497TX

General Provider Information

NPI Number : 1730534520
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY MATHIAS III D.O.
Provider Business Mailing Address
First Line : PO BOX 4930
Second Line :
City : TULSA
State : OK
Zip : 74159-0930
Country : US
Telephone Number : 918-747-4975
Fax Number :
Provider Business Practice Location Address
First Line : 5801 E 41ST ST STE 900
Second Line :
City : TULSA
State : OK
Zip : 74135-5631
Country : US
Telephone Number : 918-747-4975
Fax Number : 918-743-8552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2016
Last Update Date : 12/09/2025

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