Provider Demographics
NPI:1003014077
Name:PITTMAN, LARRY HALE JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:HALE
Last Name:PITTMAN
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2348
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-2348
Mailing Address - Country:US
Mailing Address - Phone:918-616-2386
Mailing Address - Fax:
Practice Address - Street 1:3300 CHANDLER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4957
Practice Address - Country:US
Practice Address - Phone:918-681-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK257213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery