Doctor Name: | DR. ROGER K LARSON |
NPI Number: | 1558391078 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD00007073 |
Business Practice Address: | 14212 Ambaum Blvd Sw Suite 201 Burien, WA - 981661449 |
Business Phone Number: | 2062445477 |
Business Fax Number: | 2069012678 |
Mailing Address: | 16233 Sylvester Swrd G30, BURIEN |
State: | WA |
Postal Code: | 981663045 |
Phone Number: | 2062445477 |
Fax Number: | |
NPI Enumeration Date: | 07/03/2006 |
NPI Last Update Date: | 11/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MD00007073 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |