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Individual

JOHN A LARRINAGA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
520 DOUGLAS BLVD, TYLER, TX 75702-8307
(903) 510-1175
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
L4516
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
152450601
TX
05
152466201
TX
05
152466202
TX
05
152466203
TX
01
8B0526
BCBS
TX
01
8CU211
BCBS MFH JV LOCATION
TX
01
TIN PLUS 005
TRICARE MFH JV LOCATION
TX
01
TIN PLUS 113
TRICARE
TX
Enumeration date
02/15/2006
Last updated
10/13/2014
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