Individual
MICHAEL J LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11315 BRIDGEPORT WAY SW, LAKEWOOD, WA 98499-3004
(253) 588-1711
(253) 838-6418
Mailing address
505 S 336TH ST, SUITE 600, FEDERAL WAY, WA 98003-6328
(253) 838-6180
(253) 838-6418
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00038582
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0176597
LIWA
WA
01
—
2164LA
BSWA
WA
05
—
8254039
—
WA
Enumeration date
06/12/2006
Last updated
04/26/2021
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