Provider Demographics
NPI:1720074453
Name:OLINDE, LARRY T (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:T
Last Name:OLINDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 THOMAS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-7903
Mailing Address - Country:US
Mailing Address - Phone:318-325-5435
Mailing Address - Fax:318-325-5495
Practice Address - Street 1:401 THOMAS RD STE 1
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-7903
Practice Address - Country:US
Practice Address - Phone:318-325-5435
Practice Address - Fax:318-325-5495
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018516207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H25002OtherVANTAGE
LA1903795Medicaid
E68668Medicare UPIN
H25002OtherVANTAGE