Provider Demographics
NPI:1386758100
Name:REUTZEL, LARRY JOHN
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JOHN
Last Name:REUTZEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2117
Mailing Address - Country:US
Mailing Address - Phone:319-364-4181
Mailing Address - Fax:319-363-5448
Practice Address - Street 1:617 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2117
Practice Address - Country:US
Practice Address - Phone:319-364-4181
Practice Address - Fax:319-363-5448
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA332BX2000X332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies