Provider Demographics
NPI:1144313537
Name:LAY, LARRY TRAVIS (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:TRAVIS
Last Name:LAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 INDIAN HILLS TRL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1530
Mailing Address - Country:US
Mailing Address - Phone:859-539-2817
Mailing Address - Fax:
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1886
Practice Address - Country:US
Practice Address - Phone:502-587-4404
Practice Address - Fax:502-587-4156
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39406207L00000X
OH35-123772207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200863510A (KOHMG)Medicaid
KYP01567905-KOHMGOtherRR MEDICARE
KYK121540-KOHMGOtherMEDICARE
KY64111420 (KOHMG)Medicaid
IN200863510A (KOHMG)Medicaid