MEDICARE: LARRY L LACEFIELD

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1710292172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY L LACEFIELD

Provider Business Mailing Address
First Line	:	5528 MAPLE LANDING DR
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-7031
Country	:	US
Telephone Number	:	901-874-3820
Fax Number	:

Provider Business Practice Location Address
First Line	:	5528 MAPLE LANDING DR
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-7031
Country	:	US
Telephone Number	:	901-874-3820
Fax Number	:

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

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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Directions to “ LARRY L LACEFIELD ” Practice Location

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