Organization
UPPER VALLEY ORTHOPEDICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J LARSON MD (OWNER)
(208) 356-9550
Entity
Organization
Contact information
Practice address
360 E MAIN ST, REXBURG, ID 83440-2015
(208) 356-9550
(208) 356-8023
Mailing address
360 E MAIN ST, REXBURG, ID 83440-2015
(208) 356-9550
(208) 356-8023
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M5158
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808017600
—
ID
Enumeration date
11/22/2006
Last updated
11/19/2009
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