Provider Demographics
NPI:1356459390
Name:NEUPERT, LARRY DOUGLAS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DOUGLAS
Last Name:NEUPERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7046
Mailing Address - Country:US
Mailing Address - Phone:843-797-8515
Mailing Address - Fax:
Practice Address - Street 1:104 S PEMBROKE DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7046
Practice Address - Country:US
Practice Address - Phone:843-797-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC233367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0614Medicaid
S00867Medicare UPIN
SCAN0614Medicaid