Provider Demographics
NPI:1437178886
Name:FREVERT, LARRY FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:FREDERICK
Last Name:FREVERT
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 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:
Practice Address - Street 1:120 NE SAINT LUKES BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6011
Practice Address - Country:US
Practice Address - Phone:816-246-4302
Practice Address - Fax:816-246-8910
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD36697207X00000X
MO36697207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16555017OtherBLUE CROSS BLUE SHIELD
MO2424912OtherAETNA
MO2424912OtherAETNA
MO16555017OtherBLUE CROSS BLUE SHIELD