Jefferson, Larry

Jefferson, Larry is an individual health care provider with primary practice located at 6621 Fannin St Wt 6-006, Houston TX 77030-2316. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatric Pulmonology, Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine. Allopathic & Osteopathic Physicians / Pediatric Pulmonology is his primary health care specialty. Jefferson, Larry can be contacted via phone (832) 824-6230.

Contact Information

Primary practice address
6621 Fannin St Wt 6-006 Houston TX 77030-2316
Phone: (832) 824-6230
Fax: (832) 825-2967
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Pulmonology 2080P0214X G2400 Texas
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine 2080P0203X G2400 Texas

Profile Details

NPI number 1083794341
LBN Legal business name Jefferson, Larry
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 17th, 2006
Last updated Sep 17th, 2015 - about 10 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 1083794341 NPPES
Texas MEDICAID 134850003

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