Individual
WILLIAM DAVID LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19250 SW 65TH AVE, STE 215, TUALATIN, OR 97062-7452
(503) 692-3630
(503) 692-3420
Mailing address
6420 SW MACADAM AVE, SUITE 216, PORTLAND, OR 97239-3507
(503) 244-8601
(503) 244-3013
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD10715
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060087
—
OR
01
—
180002095
RAILROAD MEDICARE
OR
Enumeration date
11/28/2005
Last updated
05/29/2013
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