Provider Demographics
NPI:1023196474
Name:LARRY W. ANTHONY M.D. P.C.
Entity Type:Organization
Organization Name:LARRY W. ANTHONY M.D. P.C.
Other - Org Name:ANTHONY'S COMPREHENSIVE MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-368-6900
Mailing Address - Street 1:3960 KNIGHT ARNOLD RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3009
Mailing Address - Country:US
Mailing Address - Phone:901-368-6900
Mailing Address - Fax:901-369-8618
Practice Address - Street 1:3960 KNIGHT ARNOLD RD STE 302
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3009
Practice Address - Country:US
Practice Address - Phone:901-368-6900
Practice Address - Fax:901-369-8618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0026373174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373169Medicare PIN
TND39307Medicare UPIN