Provider Demographics
NPI:1972689230
Name:LARRY R NARUP INC.
Entity Type:Organization
Organization Name:LARRY R NARUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NARUP
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-962-1797
Mailing Address - Street 1:8816 W PENDLETON AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2604
Mailing Address - Country:US
Mailing Address - Phone:314-962-1797
Mailing Address - Fax:314-962-0656
Practice Address - Street 1:8816 W PENDLETON AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2604
Practice Address - Country:US
Practice Address - Phone:314-962-1797
Practice Address - Fax:314-962-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000315213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015330Medicare PIN
MOT42841Medicare UPIN
MO5771220001Medicare NSC
MO000021038Medicare ID - Type Unspecified