1275644346 NPI number — JUDD L LAROWE MD PC

Table of content: (NPI 1275644346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275644346 NPI number — JUDD L LAROWE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUDD L LAROWE MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275644346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1664 S DIXIE DR STE D102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84770-7329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-656-2995
Provider Business Mailing Address Fax Number:
435-656-3237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1664 S DIXIE DR STE D102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84770-7329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-656-2995
Provider Business Practice Location Address Fax Number:
435-656-3237
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAROWE
Authorized Official First Name:
JUDD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
435-656-2995

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  374653-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 107008783103 . This is a "SELECT HEALTH ID#" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 99374653104001 . This is a "BC/BS ID#" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".