Provider Demographics
NPI:1255383766
Name:WARREN, LARIMORE C (MD, PC)
Entity type:Individual
Prefix:DR
First Name:LARIMORE
Middle Name:C
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1405 W BADDOUR PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2567
Mailing Address - Country:US
Mailing Address - Phone:615-444-3145
Mailing Address - Fax:615-444-3312
Practice Address - Street 1:1405 W BADDOUR PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2567
Practice Address - Country:US
Practice Address - Phone:615-444-3145
Practice Address - Fax:615-444-3312
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD15070208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0081749OtherHEALTHSPRING
TN3723231Medicaid
TN4074907OtherBLUE CROSS/BLUE SHIELD
TN4074907OtherTENNCARE
TN4074907OtherTENNCARE
TN4074907OtherBLUE CROSS/BLUE SHIELD
TNA97029Medicare UPIN