Provider Demographics
NPI:1821155532
Name:CRICK, LARRY GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GEORGE
Last Name:CRICK
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 1:110 3RD ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2993
Mailing Address - Country:US
Mailing Address - Phone:270-827-3573
Mailing Address - Fax:270-827-1250
Practice Address - Street 1:110 3RD ST
Practice Address - Street 2:SUITE 180
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2993
Practice Address - Country:US
Practice Address - Phone:270-827-3573
Practice Address - Fax:270-827-1250
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20235208000000X
IN01041832A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64202351Medicaid
KYC69304Medicare UPIN
KY64202351Medicaid