Provider Demographics
NPI:1912926783
Name:SONNA, LARRY ALLEN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALLEN
Last Name:SONNA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16420 SE MCGILLIVRAY BLVD STE 103-865
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3461
Mailing Address - Country:US
Mailing Address - Phone:360-606-3622
Mailing Address - Fax:
Practice Address - Street 1:16420 SE MCGILLIVRAY BLVD STE 103-865
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-3461
Practice Address - Country:US
Practice Address - Phone:360-606-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG39629207RP1001X, 207RC0200X
IDM-14425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1912926783Medicaid
MD888575-01OtherBLUE CROSS/BLUE SHIELD
MD4115571-00Medicaid
MD888575-01OtherBLUE CROSS/BLUE SHIELD
DE1912926783Medicaid