Provider Demographics
NPI:1497306468
Name:DAVID P LARSON, MD, LLC
Entity Type:Organization
Organization Name:DAVID P LARSON, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PADDOCK
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-719-2250
Mailing Address - Street 1:16043 SW WAXWING WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8362
Mailing Address - Country:US
Mailing Address - Phone:503-719-2250
Mailing Address - Fax:503-268-1210
Practice Address - Street 1:16043 SW WAXWING WAY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8362
Practice Address - Country:US
Practice Address - Phone:503-719-2250
Practice Address - Fax:503-268-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-21
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty