Organization
LARRY R BRAZLEY MD, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY R BRAZLEY MD (PHYSICIAN/OWNER)
(219) 769-1670
Entity
Organization
Contact information
Practice address
255 E 90TH DR, MERRILLVILLE, IN 46410-8144
(219) 791-0248
(219) 791-0251
Mailing address
55 E 86TH AVE, PO BOX 10645, MERRILLVILLE, IN 46410-6382
(219) 769-1670
(219) 738-6714
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
01032396
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100169080
—
IN
Enumeration date
08/04/2006
Last updated
06/09/2008
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