Healthcare Provider Details

I. General information

NPI: 1265482921
Provider Name (Legal Business Name): LARRY C KILGORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/02/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 ALCOA HWY STE 370
KNOXVILLE TN
37920-1552
US

IV. Provider business mailing address

1926 ALCOA HWY STE 370
KNOXVILLE TN
37920-1552
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-5622
  • Fax:
Mailing address:
  • Phone: 865-305-5622
  • Fax: 865-305-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number09758
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number43047
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: