Healthcare Provider Details

I. General information

NPI: 1730172537
Provider Name (Legal Business Name): LARRY H. WESTERFIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W RAVINE RD
KINGSPORT TN
37660-3810
US

IV. Provider business mailing address

3053 W STATE ST
BRISTOL TN
37620-1720
US

V. Phone/Fax

Practice location:
  • Phone: 423-968-1144
  • Fax: 423-968-3453
Mailing address:
  • Phone: 423-968-1144
  • Fax: 423-968-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10697
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: