Cruel, Larry K

Cruel, Larry K is an sole proprietor health care provider with primary practice located at 4510 Office Park Dr , Jackson MS 39206-6016. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine, which is considered as his primary health care specialty. Cruel, Larry K can be contacted via phone (601) 981-3001.

Contact Information

Primary practice address
4510 Office Park Dr Jackson MS 39206-6016
Phone: (601) 981-3001
Fax: (601) 981-8999
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine 213EP1101X 80152 Mississippi

Profile Details

NPI number 1609996982
LBN Legal business name Cruel, Larry K
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 30th, 2007
Last updated Jun 30th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609996982 NPPES
Mississippi MEDICAID 00120141

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