Individual provider · NPI-1

Larry Glen Andrew, D.O.

Family Medicine · Provo, UT

NPI number1104996610
StatusActive
Last updated in NPPESJul 3, 2013

Details

NPI
1104996610
Entity type
Individual (NPI-1)
Name
Larry Glen Andrew
Credential
D.O.
Sex
Male
Sole proprietor
Yes
Enumeration date
Nov 9, 2006
Last updated
Jul 3, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine326767-1204UTYes

Practice location

746 E 1910 S Ste 1
Provo, UT 84606-6227

Phone 801-377-0580 · Fax 801-375-5582

Mailing address

746 E 1910 S Ste 1
Provo, UT 84606-6227

Phone 801-377-0580 · Fax 801-375-5582

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