Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | OP00000821 | WA |
N | 2080P0201X | Pediatric Allergist | OP00000821 | WA |
NPI | 1306932488 |
---|---|
Provider Name | Lawrence Larson |
First Address | Tacoma, WA 98405 |
Second Address | Tacoma, WA 98405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 21/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10255717 | (05) | WA |