Provider Demographics
NPI:1891790408
Name:CHASE, LARRY K (MD)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:K
Last Name:CHASE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3525 S NATIONAL AVE
Practice Address - Street 2:STE 101
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7310
Practice Address - Country:US
Practice Address - Phone:417-269-9950
Practice Address - Fax:417-269-9959
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2019-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR2D20207R00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201827912Medicaid
MO056283966Medicare Oscar/Certification
MO201827912Medicaid