Basic Information
| Provider Information | |||||||||
| NPI: | 1265463038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAUL | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3146 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462063146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552068406 | ||||||||
| FaxNumber: | 8558238132 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 25TH AVE N STE 602 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153120600 | ||||||||
| FaxNumber: | 6153203259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 11/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 13389 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300064449 | 01 | TN | RR MCARE- CI | OTHER | 3031080 | 01 | TN | ADR BC/BS OF TN | OTHER | 3049711 | 01 | TN | PLAZA BC/BS OF TN | OTHER | 009933182 | 05 | AL | MEDICAID | 000257969 | 05 | GA | MEDICAID | 300046228 | 01 | TN | RR MCARE-ADR | OTHER |