Provider Demographics
NPI:1689655441
Name:LARIMORE, SEAN R (DO)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:R
Last Name:LARIMORE
Suffix:
Gender:M
Credentials:DO
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 889
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0889
Mailing Address - Country:US
Mailing Address - Phone:660-626-2235
Mailing Address - Fax:660-626-2090
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1443
Practice Address - Country:US
Practice Address - Phone:660-626-2235
Practice Address - Fax:660-626-2090
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431560263OtherTRICARE WEST
P00700775OtherRAILROAD MEDICARE
MO1689655441Medicaid
MO209152818Medicaid
MO209152818Medicaid
MOH74041Medicare UPIN
MO917021731Medicare ID - Type Unspecified
MO132300015Medicare PIN