Healthcare Provider Details

I. General information

NPI: 1093721722
Provider Name (Legal Business Name): NORTHWEST FAMILY PHYSICIANS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 MOORES CHAPEL RD
CHARLOTTE NC
28214-9453
US

IV. Provider business mailing address

7920 MOORES CHAPEL RD
CHARLOTTE NC
28214-9453
US

V. Phone/Fax

Practice location:
  • Phone: 704-926-7800
  • Fax: 704-926-7806
Mailing address:
  • Phone: 704-926-7800
  • Fax: 704-926-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM G. LARSEN
Title or Position: OWNER
Credential: M.D.
Phone: 704-926-7800