Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD00026176 | WA |
NPI | 1003841966 |
---|---|
Provider Name | James Raymond Larson |
First Address | Snohomish, WA 98296-8227 |
Second Address | Everett, WA 98201-1665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1662LA | B/S REGENCE 90 (01) | |
189636 | L&I (01) | |
8120719 | (05) | WA |
E17511 | (02) |