Provider Demographics
NPI:1689658718
Name:SCARBOROUGH, LARRY KEITH (M D)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:KEITH
Last Name:SCARBOROUGH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0097
Mailing Address - Country:US
Mailing Address - Phone:256-492-0131
Mailing Address - Fax:256-492-0131
Practice Address - Street 1:4055 AL HIGHWAY 9
Practice Address - Street 2:SUITE F
Practice Address - City:CEDAR BLUFF
Practice Address - State:AL
Practice Address - Zip Code:35959-5099
Practice Address - Country:US
Practice Address - Phone:256-779-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11701207Q00000X
TN18421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0110485OtherUNITEDHEALTH
AL62-1334345OtherALL OTHER INSURANCE CO
AL510-84460OtherBLUE CROSS
AL0004197385OtherAETNA
AL62-1334345OtherALL OTHER INSURANCE CO
ALA99392Medicare UPIN