Provider Demographics
NPI:1952356354
Name:MCEACHERN, LARRY EDWARD (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:EDWARD
Last Name:MCEACHERN
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 1:201 E ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-7119
Mailing Address - Country:US
Mailing Address - Phone:325-235-8641
Mailing Address - Fax:325-235-5925
Practice Address - Street 1:201 E ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7119
Practice Address - Country:US
Practice Address - Phone:325-235-8641
Practice Address - Fax:325-235-5925
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5167208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1952356354OtherNPI
TX1269946-01Medicaid
TXB24729Medicare UPIN
TX1269946-01Medicaid