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General NPI Number Information
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NPI Number | 1770582868
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Entity Type | Individual
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Provider Name | LARRY C ATWOOD M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 1515 NE LAWRIE TATUM RD
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City | LAWTON
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State | OK
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Zip | 73507-3002
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Country | US
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Telephone | 580-354-5000
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Fax | 580-354-5148
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Provider Business Mailing Address
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Address Line | 14 PALLADIO DR
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City | GREENVILLE
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State | SC
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Zip | 29617-7921
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Country | US
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Telephone | 973-917-9678
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04 19202
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License Number State | KS
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