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1659355220

NPI Code Detail

MEDICARE: DR. FRANK ANDRUS LARSON MD FACS

MEDICARE: DR. FRANK ANDRUS LARSON MD FACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD17655	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00143341	OTHER	OR	RR MEDICARE PTAN NUMBER
2	CB3544	OTHER	OR	RR MEDICARE GROUP NUMBER
5	R0000WFBTV	OTHER	OR	MEDICARE GROUP PIN NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	1407812365	OTHER	OR	NBMC NPI NUMBER-GROUP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659355220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK ANDRUS LARSON MD FACS

Provider Business Mailing Address
First Line	:	1900 WOODLAND DR
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-0000
Country	:	US
Telephone Number	:	541-267-5151
Fax Number	:	541-266-4535

Provider Business Practice Location Address
First Line	:	1900 WOODLAND DR
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-0000
Country	:	US
Telephone Number	:	541-267-5151
Fax Number	:	541-266-4535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	03/23/2010

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Directions to “ DR. FRANK ANDRUS LARSON MD FACS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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