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Individual

DR. LARRY BRYAN JENNINGS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
2263 HIGHWAY 65 NORTH, MARSHALL, AR 72650-1060
(870) 448-5733
(870) 448-3392
Mailing address
PO BOX 1060, MARSHALL, AR 72650-1060
(870) 448-5733
(870) 448-5736

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R2480
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
52660
BLUE CROSS AR
AR
01
52660B477
BLUE CROSS ARKANSAS
AR
01
P00014273
RAILROAD MEDICARE PIN
AR
Enumeration date
06/17/2005
Last updated
03/10/2008
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