Provider Demographics
NPI:1922035864
Name:SHEARS, LARRY L II (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:L
Last Name:SHEARS
Suffix:II
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 1:975 E 3RD ST
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-5661
Mailing Address - Fax:423-778-5664
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE C520
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-5661
Practice Address - Fax:423-778-5664
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55005208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G34830Medicare UPIN
G34830Medicare UPIN
PA96847OtherGEISINGER
PA001847613Medicaid
PAP00149059Medicare PIN
PA811090OtherHIGHMARK BLUE SHIELD
PA156861OtherUNISON-WMG
PA20034218OtherAMERIHEALTH MERCY-WMG
PA7313470OtherAETNA
PA2129672OtherMAMSI-WMG
MD642487OtherCAREFIRST MD BCBS
MD037214500Medicaid
PA107856OtherJOHNS HOPKINS
PA1531968OtherGATEWAY-WMG
PA50039034OtherCAPITAL BLUE CROSS-WMG