| Doctor Name: | DR. LARRY OMAR GOLDBECK |
| NPI Number: | 1407971591 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | C6952 |
| Business Practice Address: | 29601 No Le Hace Dr Fair Oaks Ranch, TX - 780154518 |
| Business Phone Number: | 8307554496 |
| Business Fax Number: | 8307554439 |
| Mailing Address: | 29601 No Le Hace Dr, FAIR OAKS RANCH |
| State: | TX |
| Postal Code: | 780154518 |
| Phone Number: | 8307554496 |
| Fax Number: | 8307554439 |
| NPI Enumeration Date: | 03/20/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204C00000X |
| License Number: | C6952 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine, Sports Medicine |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |