Provider Demographics
NPI:1760468581
Name:MILSOW, LARRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:L
Last Name:MILSOW
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 1:520 S COWLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1315
Mailing Address - Country:US
Mailing Address - Phone:509-747-3131
Mailing Address - Fax:509-747-0806
Practice Address - Street 1:520 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1315
Practice Address - Country:US
Practice Address - Phone:509-747-3131
Practice Address - Fax:509-747-0806
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20889174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1396100Medicaid
WA1396100Medicaid