Provider Demographics
NPI:1538162896
Name:FIELDS, LARRY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:MICHAEL
Last Name:FIELDS
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 1:501 19TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1854
Mailing Address - Country:US
Mailing Address - Phone:865-541-2695
Mailing Address - Fax:865-541-2696
Practice Address - Street 1:501 19TH ST
Practice Address - Street 2:SUITE 406
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1854
Practice Address - Country:US
Practice Address - Phone:865-541-2695
Practice Address - Fax:865-541-2696
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35436207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3867792Medicaid
TN4277390OtherBLUE CROSS BLUE SHIELD
TN103I166103Medicare PIN
H45945Medicare UPIN