Provider Demographics
NPI:1346739992
Name:BOANS, LARRY
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:BOANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8809 BRIAR PATCH DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1271
Mailing Address - Country:US
Mailing Address - Phone:813-525-6562
Mailing Address - Fax:
Practice Address - Street 1:8809 BRIAR PATCH DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1271
Practice Address - Country:US
Practice Address - Phone:813-525-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL82-5479764343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)