Provider Demographics
NPI:1871838847
Name:LARRY E URRY MD PC
Entity Type:Organization
Organization Name:LARRY E URRY MD PC
Other - Org Name:DRUMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:URRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-390-4536
Mailing Address - Street 1:434 E 5350 S STE D
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-5417
Mailing Address - Country:US
Mailing Address - Phone:801-827-9100
Mailing Address - Fax:801-827-9110
Practice Address - Street 1:434 E 5350 S STE D
Practice Address - Street 2:
Practice Address - City:WASHINGTON TERRACE
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-827-9100
Practice Address - Fax:801-827-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT177611-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000011725OtherMEDICARE PTAN