Healthcare Provider Details

I. General information

NPI: 1669440509
Provider Name (Legal Business Name): LARRY POE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CADILLAC DR STE 200
BRENTWOOD TN
37027
US

IV. Provider business mailing address

750 OLD HICKORY BLVD STE 1-260
BRENTWOOD TN
37027-4528
US

V. Phone/Fax

Practice location:
  • Phone: 615-376-7370
  • Fax: 615-376-7575
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number01064502A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME97617
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number58555
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberDR-45087
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number41168
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number182021
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number2007-01971
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number19813
License Number StateMS
# 9
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberTM00086
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number036-117102
License Number StateIL
# 11
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberTM2006-0470
License Number StateNM
# 12
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberM-10716
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: