Provider Demographics
NPI:1568451102
Name:LARSEN, MURRAY I (MD)
Entity Type:Individual
Prefix:
First Name:MURRAY
Middle Name:I
Last Name:LARSEN
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 1:625 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2010
Mailing Address - Country:US
Mailing Address - Phone:509-758-2200
Mailing Address - Fax:509-758-6511
Practice Address - Street 1:625 6TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2010
Practice Address - Country:US
Practice Address - Phone:509-758-2200
Practice Address - Fax:509-758-6511
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029346207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0027334Medicaid
WA2039081Medicaid
P00172342Medicare PIN
8807793Medicare PIN