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Individual

LARRY KENNETH O'BRYANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
407 14TH AVE SE, PUYALLUP, WA 98372-3770
(253) 697-5647
Mailing address
2910 16TH ST SE, PUYALLUP, WA 98374-1379

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD38704
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8286821
WA
Enumeration date
01/15/2007
Last updated
05/21/2008
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