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Individual
MARY S LAREW
Active
Individual
MARY S LAREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
21717
IA
2080A0000X
Pediatric Adolescent Medicine Physician
21717
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1207217
—
IA
01
—
56181
WELLMARK BCBS
IA
Enumeration date
09/22/2005
Last updated
09/27/2007
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