Provider Demographics
NPI:1568420610
Name:DAVIS, LARRY EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:EUGENE
Last Name:DAVIS
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 1:1924 ALCOA HWY
Mailing Address - Street 2:U-67
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-544-9352
Mailing Address - Fax:865-544-9314
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:U-115
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-544-9351
Practice Address - Fax:865-544-9314
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0162OtherJOHN DEERE
TN5459033OtherAETNA
TN146978OtherBLUE CROSS/BLUE SHIELD
TN2407783OtherCIGNA
TN3022719Medicaid
TN01-42002OtherUNITED HEALTH CARE
TN146978OtherBLUE CROSS/BLUE SHIELD
TN2407783OtherCIGNA