Provider Demographics
NPI:1265463038
Name:PAUL, LARRY H (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:H
Last Name:PAUL
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:PO BOX 3146
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3146
Mailing Address - Country:US
Mailing Address - Phone:855-206-8406
Mailing Address - Fax:855-823-8132
Practice Address - Street 1:210 25TH AVE N STE 602
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1631
Practice Address - Country:US
Practice Address - Phone:615-312-0600
Practice Address - Fax:615-320-3259
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN133892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN300064449OtherRR MCARE- CI
TN3031080OtherADR BC/BS OF TN
TN3049711OtherPLAZA BC/BS OF TN
AL009933182Medicaid
GA000257969Medicaid
TN300046228OtherRR MCARE-ADR
TN300046228Medicare PIN
AL009933182Medicaid
TN3037372Medicare PIN
TN3049711OtherPLAZA BC/BS OF TN
TN3037376Medicare PIN