Active NPI
Larry Dale Withers, MD
- Anesthesiology Physician
- Fayetteville, NC
National Provider Identifier
1043311301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 24316
- Practice address
- 1638 Owen Dr
Fayetteville, NC 28304-3424 - Phone
- (910) 323-8594
- Fax
- (910) 323-5795
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 24316 | NC | Primary |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 24316 | NC |
Addresses
Primary practice location
1638 Owen Dr
Fayetteville, NC 28304-3424
Mailing address
PO Box 53844
Fayetteville, NC 28305-3844
Phone (910) 323-8594
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8988664 | Medicaid | NC | |
| 50011540 | Other | NC | RAILROAD MEDICARE |
| 88664 | Other | NC | BLUE CROSS BLUE SHIELD |
| 88664 | Other | NC | STATE HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24316 | NC | MD | Pain Medicine (Anesthesiology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191801600000",
"number": "1043311301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 53844",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283053844",
"telephone_number": "910-323-8594",
"fax_number": "910-323-5795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1638 OWEN DR",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043424",
"telephone_number": "910-323-8594",
"fax_number": "910-323-5795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITHERS",
"first_name": "LARRY",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2007-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NC",
"license": "24316",
"primary": true
},
{
"code": "207LP2900X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pain Medicine",
"state": "NC",
"license": "24316",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8988664",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "50011540",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "88664",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE HEALTH PLAN",
"identifier": "88664",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.