Provider Demographics
NPI:1609824143
Name:LARSON, STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:LARSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1758
Mailing Address - Country:US
Mailing Address - Phone:208-785-5801
Mailing Address - Fax:208-785-3504
Practice Address - Street 1:326 POPLAR ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1741
Practice Address - Country:US
Practice Address - Phone:208-785-5801
Practice Address - Fax:208-785-3504
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-152207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010167600OtherRBS LAMERE
IDS6115OtherBLUE CROSS ID
ID002331000Medicaid
IDS5601OtherBLUE CROSS OLD
IDS6243OtherBCS LAMERE
ID266528OtherALTIUS OLD
ID312970OtherALTIUS
ID000010001960OtherREGENCE BLUE SHIELD
ID1130476Medicare PIN
IDS6115OtherBLUE CROSS ID
ID312970OtherALTIUS
ID000010001960OtherREGENCE BLUE SHIELD