Provider Demographics
NPI:1376609875
Name:LARRY GUERIN MD
Entity Type:Organization
Organization Name:LARRY GUERIN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-335-8638
Mailing Address - Street 1:UNIT 48
Mailing Address - Street 2:PO BOX 5000
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-5000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 NE 47TH AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2238
Practice Address - Country:US
Practice Address - Phone:909-335-8638
Practice Address - Fax:909-335-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000BKBSRMedicare ID - Type Unspecified