Individual
BEVERLY ANN LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
1800 HEAGON ST, LAMAR, MO 64759-2330
(417) 681-9006
(417) 681-9006
Mailing address
1800 HEAGON ST, LAMAR, MO 64759-2330
(417) 681-9006
(417) 681-9006
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
109834
MO
Other
Enumeration date
01/25/2007
Last updated
07/08/2007
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