Provider Demographics
NPI:1568526051
Name:WITHERSPOON, LOYD WILLIAM JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOYD
Middle Name:WILLIAM
Last Name:WITHERSPOON
Suffix:JR
Gender:M
Credentials:DPM
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Mailing Address - Street 1:5000 W ESPLANADE AVE
Mailing Address - Street 2:PMB 235
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2551
Mailing Address - Country:US
Mailing Address - Phone:504-779-8120
Mailing Address - Fax:504-779-9741
Practice Address - Street 1:1510 GUNBARREL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7174
Practice Address - Country:US
Practice Address - Phone:423-499-6488
Practice Address - Fax:423-855-4100
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2012-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNDPM380213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3353790Medicaid
TN480035339OtherRAILROAD MEDICARE
GA000776058AMedicaid
TN4047259OtherBLUE CROSS
TN412064222001OtherTRICARE
TNDA2202OtherRAILROAD MEDICARE GROUP
TNTN0101OtherUHC OF RIVER VALLEY
TN3353790Medicaid
GA000776058AMedicaid