Provider Demographics
NPI:1578865390
Name:LARRY S. FELTS, M.D. PA
Entity Type:Organization
Organization Name:LARRY S. FELTS, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-931-0434
Mailing Address - Street 1:PO BOX 17357
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6725
Mailing Address - Country:US
Mailing Address - Phone:870-931-0434
Mailing Address - Fax:870-931-0435
Practice Address - Street 1:4508 STADIUM BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9675
Practice Address - Country:US
Practice Address - Phone:870-931-0434
Practice Address - Fax:870-931-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty