Healthcare Provider Details

I. General information

NPI: 1568451102
Provider Name (Legal Business Name): MURRAY I LARSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 01/29/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 6TH ST
CLARKSTON WA
99403-2010
US

IV. Provider business mailing address

625 6TH ST
CLARKSTON WA
99403-2010
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-2200
  • Fax: 509-758-6511
Mailing address:
  • Phone: 509-758-2200
  • Fax: 509-758-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD00029346
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: