Provider Demographics
NPI:1295951093
Name:MORELOCK, LARRY RONALD (CONTRACTOR)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:RONALD
Last Name:MORELOCK
Suffix:
Gender:M
Credentials:CONTRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5259 DENMANS LOOP
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-4940
Mailing Address - Country:US
Mailing Address - Phone:512-635-8108
Mailing Address - Fax:254-939-6665
Practice Address - Street 1:5259 DENMANS LOOP
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-4940
Practice Address - Country:US
Practice Address - Phone:512-635-8108
Practice Address - Fax:254-939-6665
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10066045OtherPROVIDER ID
TX10066045OtherPROVIDER ID