Provider Demographics
NPI:1497117246
Name:LARSON, ERIK WERNER (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:WERNER
Last Name:LARSON
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 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-3800
Mailing Address - Fax:208-625-3801
Practice Address - Street 1:2288 N MERRIT CRK LOOP STE 200
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4992
Practice Address - Country:US
Practice Address - Phone:208-625-3800
Practice Address - Fax:208-625-3801
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDM-17134207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program