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Individual
DR. LARRY WAYNE DESCH
Active
Individual
DR. LARRY WAYNE DESCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036093057
IL
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
036-093057
IL
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
036093057
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036093057
STATE LICENSE
IL
01
—
14D0419824
CLIA
IL
Enumeration date
08/29/2006
Last updated
12/17/2021
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