Individual
LARRY KEITH VUNCANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
503 CONSTITUTION DR, IUKA, MS 38852-8201
(662) 424-9500
(662) 424-9592
Mailing address
503 CONSTITUTION DR, IUKA, MS 38852-8201
(662) 424-9500
(662) 424-9592
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT1052
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119836
—
MS
Enumeration date
01/31/2007
Last updated
07/08/2007
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