Provider Demographics
NPI:1295804425
Name:CURTIS, LARRY T (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:T
Last Name:CURTIS
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 1:167 E 1ST S
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-1401
Mailing Address - Country:US
Mailing Address - Phone:208-745-8747
Mailing Address - Fax:208-745-9396
Practice Address - Street 1:167 E 1ST S
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1401
Practice Address - Country:US
Practice Address - Phone:208-745-8747
Practice Address - Fax:208-745-9396
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSPHY-5053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002661700Medicaid
ID002661700Medicaid
ID1118764Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL