Basic Information
| Provider Information | |||||||||
| NPI: | 1669440509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POE | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 OLD HICKORY BLVD | ||||||||
| Address2: | STE 1-260 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274528 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8 CADILLAC DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153767370 | ||||||||
| FaxNumber: | 6153767575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 01064502A | IN | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | ME97617 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 58555 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | DR-45087 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 41168 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 182021 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085N0700X | 2007-01971 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 19813 | MS | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | TM00086 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 036-117102 | IL | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | TM2006-0470 | NM | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | M-10716 | ID | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | 3829018 | 05 | TN | MEDICAID |