Individual
MR. LARRY PAUL PENWRIGHT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HIS
Contact information
Practice address
703 N BROADWAY AVE, SUITE 2, ADA, OK 74820-3457
(580) 436-3277
(580) 436-5046
Mailing address
703 N BROADWAY AVE, SUITE 2, ADA, OK 74820-3457
(580) 436-3277
(580) 436-5046
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
595
OK
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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