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NPI Code Detail

MEDICARE: LARRY C ATWOOD M.D.

MEDICARE:   LARRY C ATWOOD  M.D.
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
1207Q00000XFamily Medicine Physician04 19202KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MD452498OTHERPAMEDICAL LICENSE

General Provider Information

NPI Number : 1770582868
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY C ATWOOD M.D.
Provider Business Mailing Address
First Line : 14 PALLADIO DR
Second Line :
City : GREENVILLE
State : SC
Zip : 29617-7921
Country : US
Telephone Number : 973-917-9678
Fax Number :
Provider Business Practice Location Address
First Line : 1515 NE LAWRIE TATUM RD
Second Line :
City : LAWTON
State : OK
Zip : 73507-3002
Country : US
Telephone Number : 580-354-5000
Fax Number : 580-354-5148
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 08/11/2014

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Directions to “ LARRY C ATWOOD M.D.” Practice Location

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