Individual
DR. LARRY W CARRUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
96 PHYSICIANS DR, 96 PHYSICIANS DRIVE, JACKSON, TN 38305-2070
(731) 664-8771
(731) 660-7050
Mailing address
96 PHYSICIANS DR, 96 PHYSICIANS DRIVE, JACKSON, TN 38305-2070
(731) 664-8771
(731) 660-7050
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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