Provider Demographics
NPI:1235248105
Name:DIPBOYE, LARRY K (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:K
Last Name:DIPBOYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 OLIVE WAY MSC M4-PA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI2541OtherBLUE SHIELD
WAMD3180OtherALASKA MEDICAID
WA8242356Medicaid
WA0039581OtherLABOR & INDUSTRY
WAUS5835725OtherAETNA/USHC SPECIALIST
930086693OtherRAILROAD MEDICARE
WA8852083Medicare PIN
WAAB11933Medicare PIN
WA8809213Medicare PIN
WA8242356Medicaid