Provider Demographics
NPI:1225005622
Name:LEFEVRE, LARRY E (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:LEFEVRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 E US HIGHWAY 36
Mailing Address - Street 2:STE. B
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9112
Mailing Address - Country:US
Mailing Address - Phone:937-652-4969
Mailing Address - Fax:937-652-4970
Practice Address - Street 1:1430 E US HIGHWAY 36
Practice Address - Street 2:STE. B
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9112
Practice Address - Country:US
Practice Address - Phone:937-652-4969
Practice Address - Fax:937-652-4970
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0305315Medicaid
A75564Medicare UPIN
OH0305315Medicaid