Individual
DR. LARRY T JUSTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
80 VERMONT AVE, OAK RIDGE, TN 37830-6474
(865) 482-4078
(865) 482-4960
Mailing address
80 VERMONT AVE, OAK RIDGE, TN 37830-6474
(865) 482-4078
(865) 482-4960
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
40574
TN
207RI0011X
Interventional Cardiology Physician
40574
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3338151
—
TN
05
—
3379860
—
TN
01
—
4125100
BCBST
TN
01
—
7100065540
KYMEDICAID
—
05
—
Q009959
—
TN
Enumeration date
06/20/2006
Last updated
09/18/2020
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