Larry Glen Andrew, D.O.
Family Medicine in Provo, UT. Individual provider (NPI-1).
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 code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 326767-1204 | UT | Yes |
Practice location
746 E 1910 S Ste 1Provo, UT 84606-6227
Phone 801-377-0580 · Fax 801-375-5582
Mailing address
746 E 1910 S Ste 1Provo, UT 84606-6227
Phone 801-377-0580 · Fax 801-375-5582
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