MEDICARE: LARRY CLARK FIELD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	2005-01864	NC

General Provider Information

NPI Number	:	1326060385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY CLARK FIELD MD

Provider Business Mailing Address
First Line	:	25 COURTENAY DR
Second Line	:	SUITE 4200
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8911
Country	:	US
Telephone Number	:	834-876-5744
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 COURTENAY DR
Second Line	:	SUITE 4200
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8911
Country	:	US
Telephone Number	:	834-876-5744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	09/06/2011

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