Provider Demographics
NPI:1639123805
Name:SEALS, LARRY E (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:SEALS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3011 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2546
Mailing Address - Country:US
Mailing Address - Phone:620-231-9873
Mailing Address - Fax:620-240-5062
Practice Address - Street 1:401 WOODLAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-8797
Practice Address - Country:US
Practice Address - Phone:620-223-8040
Practice Address - Fax:620-223-8001
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-31674207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200362170AMedicaid
KSBS105215OtherMEDICARE ID TYPE UNSPECIFIED
KSH20646Medicare UPIN