Provider Demographics
NPI:1861605107
Name:HOWARD, LARRY (PA)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STADIUM DRIVE
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380
Mailing Address - Country:US
Mailing Address - Phone:940-889-5583
Mailing Address - Fax:940-889-8835
Practice Address - Street 1:201 STADIUM DRIVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380
Practice Address - Country:US
Practice Address - Phone:940-889-5583
Practice Address - Fax:940-889-8835
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8A9190Medicare ID - Type Unspecified
P94064Medicare UPIN