Provider Demographics
NPI:1801890678
Name:PIPER, LARRY WILLIAM (DPM)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WILLIAM
Last Name:PIPER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005A W SAINT MAARTENS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2989
Mailing Address - Country:US
Mailing Address - Phone:816-364-2338
Mailing Address - Fax:816-364-1003
Practice Address - Street 1:1005A W SAINT MAARTENS DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2989
Practice Address - Country:US
Practice Address - Phone:816-364-2338
Practice Address - Fax:816-364-1003
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000362213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42461Medicare UPIN
KSQ873075Medicare ID - Type Unspecified