Individual
DR. LARRY DALE WITHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1638 OWEN DR, FAYETTEVILLE, NC 28304-3424
(910) 323-8594
(910) 323-5795
Mailing address
PO BOX 53844, FAYETTEVILLE, NC 28305-3844
(910) 323-8594
(910) 323-5795
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
24316
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
24316
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50011540
RAILROAD MEDICARE
NC
01
—
88664
BLUE CROSS BLUE SHIELD
NC
05
—
8988664
—
NC
Enumeration date
09/26/2006
Last updated
10/08/2007
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