Provider Demographics
NPI:1205236833
Name:BIRDINE, LARRY JR
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:BIRDINE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9634
Mailing Address - Country:US
Mailing Address - Phone:405-626-0567
Mailing Address - Fax:
Practice Address - Street 1:2714 LAUREL DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-9634
Practice Address - Country:US
Practice Address - Phone:405-626-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor