Wilcken, Larry T

Wilcken, Larry T is an individual health care provider with primary practice located at 151 W 200 N , Vernal UT 84078-1907. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wilcken, Larry T can be contacted via phone (435) 789-3342.

Contact Information

Primary practice address
151 W 200 N Vernal UT 84078-1907
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 158064-1205 Utah

Profile Details

NPI number 1790817013
LBN Legal business name Wilcken, Larry T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 12th, 2007
Last updated Mar 16th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790817013 NPPES
Utah MEDICAID 05135
Utah MEDICAID H1232

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