Provider Demographics
NPI:1902891815
Name:WARMOTH, LARRY A (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:WARMOTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 S LOOP 289 UNIT 65309
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79464-6956
Mailing Address - Country:US
Mailing Address - Phone:806-794-8413
Mailing Address - Fax:806-407-3138
Practice Address - Street 1:3801 21ST ST STE 200
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1006
Practice Address - Country:US
Practice Address - Phone:806-687-0338
Practice Address - Fax:806-687-4326
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4599207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
223865699OtherTRICARE
TX0086JPOtherBLUE CROSS BLUE SHIELD
TX117567107Medicaid
TX0086JPOtherBLUE CROSS BLUE SHIELD
TX100265100OtherFIRSTCARE
223865699OtherTRICARE
223865699OtherTRICARE
TX117567108Medicaid
TX00514HMedicare PIN