Provider Demographics
NPI:1881659407
Name:LARRISON, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LARRISON
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 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL248462085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051539863OtherBLUE CROSS
ALI52158OtherVIVA
AL009941547Medicaid
AL09938413Medicaid
AL051539861OtherBLUE CROSS
AL51536872OtherBLUE CROSS BLUE SHIELD
AL051539864OtherBLUE CROSS
AL009941552Medicaid
AL009941549Medicaid
AL009941551Medicaid
AL051539862OtherBLUE CROSS
MS07438371Medicaid
AL009941548Medicaid
AL051539865OtherBLUE CROSS
AL051539861OtherBLUE CROSS
AL009941552Medicaid
AL051559005Medicare PIN