Larry Gene Cromwell, MD
Individual provider Active NPI Diagnostic Radiology Physician · Payson, AZ
NPI 1407874399 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1407874399
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 27030 (AZ)
- Practice address
- 807 S Ponderosa St
Payson, AZ 85541-5542 - Phone
- (928) 472-1357
- Fax
- (928) 472-1290
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13620 | NE | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Payson Hospital Corporation | Past | Accepting new patients | |
| Payson Healthcare Management Inc | Diagnostic Radiology | Past |
Accepting new patients |
| Lincoln Radiology Group PC | Diagnostic Radiology | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 27030 | AZ | Yes |
Addresses
Primary practice location
807 S Ponderosa St
Payson, AZ 85541-5542
Mailing address
807 S Ponderosa St
Payson, AZ 85541-5542
Phone (928) 472-1357
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All providers in Payson, AZ · Diagnostic Radiology Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.