Provider Demographics
NPI:1184690695
Name:LARZALERE, JAMES RAY (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RAY
Last Name:LARZALERE
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 1:1233 N MAIN
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460
Mailing Address - Country:US
Mailing Address - Phone:620-241-4272
Mailing Address - Fax:620-241-5101
Practice Address - Street 1:1233 N MAIN
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460
Practice Address - Country:US
Practice Address - Phone:620-241-4272
Practice Address - Fax:620-241-5101
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421046207Q00000X, 207RG0300X, 207RS0010X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Not Answered207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20235LAMedicare ID - Type Unspecified
B91270Medicare UPIN