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General NPI Number Information
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NPI Number | 1881617488
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Entity Type | Individual
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Provider Name | ROBERT LARSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 26004 104TH AVE SE
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City | KENT
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State | WA
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Zip | 98030-7677
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Country | US
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Telephone | 425-251-4040
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Fax | 877-514-9952
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Provider Business Mailing Address
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Address Line | 605 WELCH ST
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City | SILVERTON
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State | OR
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Zip | 97381-1946
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Country | US
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Telephone | 503-873-6907
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Fax | 503-873-8923
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD17821
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD61360488
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License Number State | WA
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