MEDICARE: LARRY MICHAEL FIELDS 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	207V00000X	Obstetrics & Gynecology Physician	MD35436	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4277390	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1538162896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY MICHAEL FIELDS MD

Provider Business Mailing Address
First Line	:	501 19TH ST
Second Line	:	SUITE 304
City	:	KNOXVILLE
State	:	TN
Zip	:	37916-1854
Country	:	US
Telephone Number	:	865-541-2695
Fax Number	:	865-541-2696

Provider Business Practice Location Address
First Line	:	501 19TH ST
Second Line	:	SUITE 406
City	:	KNOXVILLE
State	:	TN
Zip	:	37916-1854
Country	:	US
Telephone Number	:	865-541-2695
Fax Number	:	865-541-2696

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/04/2011

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