Basic Information
| Provider Information | |||||||||
| NPI: | 1639123805 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEALS | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3011 N MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667622546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202319873 | ||||||||
| FaxNumber: | 6202405062 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 WOODLAND HILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT SCOTT | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667018797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202238040 | ||||||||
| FaxNumber: | 6202238001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 05-31674 | KS | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.