Provider Demographics
NPI:1659355220
Name:LARSON, FRANK ANDRUS (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ANDRUS
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4535
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4535
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17655208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00143341OtherRR MEDICARE PTAN NUMBER
ORCB3544OtherRR MEDICARE GROUP NUMBER
OR1407812365OtherNBMC NPI NUMBER-GROUP
OR041629Medicaid
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
ORP00143341OtherRR MEDICARE PTAN NUMBER
ORF24415Medicare UPIN
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
ORCB3544OtherRR MEDICARE GROUP NUMBER