Provider Demographics
NPI:1609030709
Name:WEBB, LARRY D
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:WEBB
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 1:14755 W RH JOHNSON BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6059
Mailing Address - Country:US
Mailing Address - Phone:623-214-5885
Mailing Address - Fax:
Practice Address - Street 1:14755 W RH JOHNSON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6059
Practice Address - Country:US
Practice Address - Phone:623-214-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07548958P237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist