Individual
DR. LARRY W CARRUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD009363
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050023
BCBS OF TN
TN
05
—
3170825
—
TN
01
—
621582944
TAX ID -COMMERCIAL INS
TN
Enumeration date
10/20/2005
Last updated
04/06/2015
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