Provider Demographics
NPI:1609994342
Name:LEFORS, LARRY S (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:S
Last Name:LEFORS
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:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-0843
Mailing Address - Country:US
Mailing Address - Phone:509-829-5221
Mailing Address - Fax:509-829-6411
Practice Address - Street 1:618 RAILROAD AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953-0843
Practice Address - Country:US
Practice Address - Phone:509-829-5221
Practice Address - Fax:509-829-6411
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1356807Medicaid
WA15993OtherLABOR AND INDUSTRIES
WA15993OtherLABOR AND INDUSTRIES