Provider Demographics
NPI:1710292172
Name:LACEFIELD, LARRY L
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:L
Last Name:LACEFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5528 MAPLE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-7031
Mailing Address - Country:US
Mailing Address - Phone:901-874-3820
Mailing Address - Fax:
Practice Address - Street 1:5528 MAPLE LANDING DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-7031
Practice Address - Country:US
Practice Address - Phone:901-874-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman