Provider Demographics
NPI:1861521825
Name:LARRY L. MAPLES, D.O., P.A.
Entity type:Organization
Organization Name:LARRY L. MAPLES, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEN
Authorized Official - Last Name:MAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-631-0544
Mailing Address - Street 1:203 S DAUGHERTY AVE
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-2607
Mailing Address - Country:US
Mailing Address - Phone:254-631-0544
Mailing Address - Fax:254-631-0426
Practice Address - Street 1:203 S DAUGHERTY AVE
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2607
Practice Address - Country:US
Practice Address - Phone:254-631-0544
Practice Address - Fax:254-631-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF53424Medicare UPIN