Provider Demographics
NPI:1649214362
Name:WEITZENKAMP, LARRY ALVIN (M D)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALVIN
Last Name:WEITZENKAMP
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:SD
Mailing Address - Zip Code:57551-0370
Mailing Address - Country:US
Mailing Address - Phone:605-685-1450
Mailing Address - Fax:605-685-1453
Practice Address - Street 1:109 PUGH ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:SD
Practice Address - Zip Code:57551-0370
Practice Address - Country:US
Practice Address - Phone:605-685-1450
Practice Address - Fax:605-685-1453
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5461207Q00000X
SD2498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine