Provider Demographics
NPI:1669440509
Name:POE, LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:POE
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 1:750 OLD HICKORY BLVD
Mailing Address - Street 2:STE 1-260
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 CADILLAC DR
Practice Address - Street 2:STE 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-376-7370
Practice Address - Fax:615-376-7575
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064502A2085N0700X
FLME976172085N0700X
GA585552085N0700X
CODR-450872085N0700X
TN411682085N0700X
NY1820212085R0202X
NC2007-019712085N0700X
MS198132085N0700X
TXTM000862085N0700X
IL036-1171022085N0700X
NMTM2006-04702085N0700X
IDM-107162085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3829018Medicaid
E30629Medicare UPIN
TN3829018Medicare PIN