Provider Demographics
NPI:1457406167
Name:LARRY TREMPER, D.O.,PLLC
Entity Type:Organization
Organization Name:LARRY TREMPER, D.O.,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:TREMPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:915-544-3229
Mailing Address - Street 1:1201 E SCHUSTER AVE STE 5B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4676
Mailing Address - Country:US
Mailing Address - Phone:915-544-3229
Mailing Address - Fax:915-544-3091
Practice Address - Street 1:1201 E SCHUSTER AVE STE 5B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4676
Practice Address - Country:US
Practice Address - Phone:915-544-3229
Practice Address - Fax:915-544-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00764363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTEXAS TAX ID