Provider Demographics
NPI:1033166616
Name:MAPLES, LARRY LEN (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEN
Last Name:MAPLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 S HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:76424-4711
Mailing Address - Country:US
Mailing Address - Phone:254-559-3363
Mailing Address - Fax:254-559-2572
Practice Address - Street 1:101 S HARTFORD ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424-4711
Practice Address - Country:US
Practice Address - Phone:254-559-3363
Practice Address - Fax:254-559-2572
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0090207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF53424Medicare UPIN
TX269742ZMFUMedicare PIN