Provider Demographics
NPI:1427218270
Name:LARRYMORE, DAVID CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTIAN
Last Name:LARRYMORE
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 1:565 EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-5074
Mailing Address - Country:US
Mailing Address - Phone:360-582-0808
Mailing Address - Fax:360-683-2712
Practice Address - Street 1:565 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-5074
Practice Address - Country:US
Practice Address - Phone:360-582-0808
Practice Address - Fax:360-683-2712
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25621207N00000X
WAMD61130459207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2189218Medicaid