Provider Demographics
NPI:1679718506
Name:PUTHENPARAMBIL, LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:PUTHENPARAMBIL
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 1:8540 BROADWAY ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7710
Mailing Address - Country:US
Mailing Address - Phone:832-727-1771
Mailing Address - Fax:
Practice Address - Street 1:8540 BROADWAY ST STE 210
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7710
Practice Address - Country:US
Practice Address - Phone:832-727-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2345207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX301100908Medicaid