Organization
LARRY D IVERSEN MD LTD PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY D IVERSEN M.D. (OWNER)
(360) 479-2525
Entity
Organization
Contact information
Practice address
840 CALLAHAN DR, SUITE C, BREMERTON, WA 98310-3378
(360) 479-2525
(360) 479-0877
Mailing address
840 CALLAHAN DR, SUITE C, BREMERTON, WA 98310-3378
(360) 479-2525
(360) 479-0877
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD00012070
WA
Other
Enumeration date
03/29/2007
Last updated
11/19/2007
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