Individual
DR. LARKIN TYLER WADSWORTH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8225 CLAYTON RD, SAINT LOUIS, MO 63117-1107
(314) 721-7325
(314) 721-1157
Mailing address
8225 CLAYTON RD, SAINT LOUIS, MO 63117-1107
(314) 721-7325
(314) 721-1157
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036118172
IL
207QS0010X
Sports Medicine (Family Medicine) Physician
036118172
IL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
103386
MO
Other
Enumeration date
10/04/2006
Last updated
08/10/2012
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