Provider Demographics
NPI:1760473102
Name:MITCHELL, LARRY GILMER (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GILMER
Last Name:MITCHELL
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:P.O. BOX CVPA
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VI
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-964-6771
Mailing Address - Fax:
Practice Address - Street 1:1 CLINIC DR
Practice Address - Street 2:CLAYPOOL HILL
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1100
Practice Address - Country:US
Practice Address - Phone:276-964-6771
Practice Address - Fax:276-964-1321
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0053207-000Medicaid
002655OtherANTHEM BCBS
VA5636264Medicaid
KY64666670Medicaid
002655OtherANTHEM BCBS