NPI 1124237730

Larry Edward Terrell, CACIII

Practitioner Specialist Pueblo, CO

Practice location

Address: 1711 E Evans Ave, Pueblo, CO 81004-3349
Phone: (719) 561-9850
Mailing address: 3470 Baltimore Ave, Pueblo, CO 81008-1520

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 3164 (CO)

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Registry record

NPI: 1124237730
Entity type: Individual
Sex (as registered): Male
NPI issued: 21 May 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.