Provider Demographics
NPI:1033215611
Name:VOELKER, LARRY JOE (DO)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JOE
Last Name:VOELKER
Suffix:
Gender:M
Credentials:DO
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 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:30012 N CAVE CREEK RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5833
Practice Address - Country:US
Practice Address - Phone:480-419-1824
Practice Address - Fax:480-419-3597
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3356204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103001OtherPACIFICARE
AZ2370432OtherAETNA
AZ520694Medicaid
AZ8590128001OtherCIGNA
AZAZ0875880OtherBCBS
AZZ62757Medicare ID - Type Unspecified
AZ103001OtherPACIFICARE
AZ2370432OtherAETNA