Provider Demographics
NPI:1558330258
Name:FITE, LARRY C (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:C
Last Name:FITE
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 1:11100 S MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2122
Mailing Address - Country:US
Mailing Address - Phone:256-650-4665
Mailing Address - Fax:256-650-4624
Practice Address - Street 1:11100 S MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-2122
Practice Address - Country:US
Practice Address - Phone:256-650-4665
Practice Address - Fax:256-650-4624
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4089717OtherAETNA
AL51511369OtherBLUE CROSS BLUE SHIELD
ALC72223Medicare UPIN
AL51511369Medicare ID - Type Unspecified