Larry T Wilcken, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

158064-1205 Issued in UT

Practice address

151 W 200 N
Vernal, UT 84078-1907

Phone

(435) 789-3342

NPI assigned

Mar 12, 2007

Last updated

Mar 16, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268697600000",
    "number": "1790817013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3618 DRY FORK CANYON RD",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840789404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 W 200 N",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840781907",
            "telephone_number": "435-789-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCKEN",
        "first_name": "LARRY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2010-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "158064-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05135",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H1232",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ally Weber, M.S., BCBA, LBA
• Ryan Ilene Webster, BCBA
• White Smiles Pediatric Dentistry
• Dallon Whitney, P.A.
• Aaron Scott Wickel
• Amy Lynne Wilson
• Michael Wilson, P.A.
• Ann Marie Winn, SSW
• Tracy Lee Winterton, FNP-BC
• Jordan Witbeck

• Family Medicine Physician in Vernal, UT
• Providers in Vernal, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.