Provider Demographics
NPI:1275644346
Name:JUDD L LAROWE MD PC
Entity Type:Organization
Organization Name:JUDD L LAROWE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDD
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAROWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-656-2995
Mailing Address - Street 1:1664 S DIXIE DR STE D102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7329
Mailing Address - Country:US
Mailing Address - Phone:435-656-2995
Mailing Address - Fax:435-656-3237
Practice Address - Street 1:1664 S DIXIE DR STE D102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7329
Practice Address - Country:US
Practice Address - Phone:435-656-2995
Practice Address - Fax:435-656-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT374653-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107008783103OtherSELECT HEALTH ID#
UT99374653104001OtherBC/BS ID#
UT000057770Medicare PIN
UT99374653104001OtherBC/BS ID#
UT000057770Medicare PIN