Provider Demographics
NPI:1811096589
Name:ENSZ, LARRY J (DO)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:ENSZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20326 ANTLER FARMS DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-0633
Mailing Address - Country:US
Mailing Address - Phone:405-471-4755
Mailing Address - Fax:
Practice Address - Street 1:20326 ANTLER FARMS DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-0633
Practice Address - Country:US
Practice Address - Phone:405-471-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E09840Medicare UPIN
46751Medicare ID - Type Unspecified