Individual
LARRY GEORGE FICKENSCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
UNIVERSITY OF OREGON STUDENT HEALTH CENTER, 1590 EAST 13TH AVENUE, EUGENE, OR 97403-1232
(541) 346-4447
(541) 346-2747
Mailing address
3945 TIMBERCREST RD, EUGENE, OR 97405-4974
(541) 484-4976
(541) 484-2587
Taxonomy
Speciality
Code
Description
License number
State
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
11339
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007179
OMAP
OR
Enumeration date
04/18/2007
Last updated
07/08/2007
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