Individual
LYLE WILBUR LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
UNIVERSITY OF WASHINGTON MEDICAL CTR, 1959 NE PACIFIC ST, SEATTLE, WA 98195-6043
(206) 598-4300
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10001429
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7833
INTERNAL ID-MOTOR VEHICLE ID
—
05
—
8320616
—
WA
Enumeration date
10/13/2006
Last updated
07/08/2007
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