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General NPI Number Information
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NPI Number | 1801814892
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Entity Type | Individual
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Provider Name | LARRY R. NELSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1800 COOKS HILL RD
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City | CENTRALIA
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State | WA
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Zip | 98531-9072
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Country | US
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Telephone | 360-736-0713
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Fax | 360-330-8680
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Provider Business Mailing Address
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Address Line | 1401 MARVIN RD NE SUITE 307 PMB 266
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City | LACEY
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State | WA
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Zip | 98516-5709
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Country | US
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Telephone | 360-491-5055
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Fax | 360-491-5890
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 252-9 0013431
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License Number State | WA
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