Provider Demographics
NPI:1134962715
Name:PEPPER, LARRY JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JAMES
Last Name:PEPPER
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 1:5775 CAROLINE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850-9678
Mailing Address - Country:US
Mailing Address - Phone:989-317-6280
Mailing Address - Fax:
Practice Address - Street 1:5775 CAROLINE DR
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-9678
Practice Address - Country:US
Practice Address - Phone:989-317-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIQ1982052083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine