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Organization
ROGER K LARSON MD PS
Active
Organization
ROGER K LARSON MD PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER K LARSON MD (AUTHORIZED OFFICIAL)
(206) 244-5477
Entity
Organization
Contact information
Practice address
14212 AMBAUM BLVD SW, SUITE 201, BURIEN, WA 98166-1449
(206) 244-5477
Mailing address
14212 AMBAUM BLVD SW, SUITE 201, BURIEN, WA 98166-1449
(206) 244-5477
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00007073
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011899328
RR MEDICARE
WA
05
—
7132384
—
WA
Enumeration date
08/31/2005
Last updated
09/19/2011
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