Provider Demographics
NPI:1649350505
Name:PARSONS, LARRY LONDIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LONDIS
Last Name:PARSONS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:531 KENNINGHAM BRANCH RD.
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:KY
Mailing Address - Zip Code:40997-0467
Mailing Address - Country:US
Mailing Address - Phone:606-545-0400
Mailing Address - Fax:606-545-0433
Practice Address - Street 1:215 TREUHAFT BLVD
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7361
Practice Address - Country:US
Practice Address - Phone:606-545-0400
Practice Address - Fax:606-545-0433
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34973208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64015803Medicaid
KY1895001Medicare ID - Type Unspecified
KY64015803Medicaid