Provider Demographics
NPI:1306850623
Name:LARRY K. KILLEBREW, MD, INC
Entity Type:Organization
Organization Name:LARRY K. KILLEBREW, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KILLEBREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-858-2350
Mailing Address - Street 1:2224 NW 50TH ST
Mailing Address - Street 2:SUITE 276W
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8046
Mailing Address - Country:US
Mailing Address - Phone:405-858-2350
Mailing Address - Fax:
Practice Address - Street 1:1500 N GREEN AVE
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1642
Practice Address - Country:US
Practice Address - Phone:405-527-6524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty