Individual
DR. RONALD K LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10150 SE 32ND AVE, MILWAUKIE, OR 97222-6516
(503) 513-8350
Mailing address
PO BOX 2739, OREGON CITY, OR 97045-0221
(503) 656-0315
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
MD15506
OR
2085R0202X
Diagnostic Radiology Physician
Primary
MD15506
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063180
—
OR
01
—
MD15506
STATE LICENSE
OR
01
—
R0000WCTBS
NOVA 'GROUP' MEDICARE #
OR
Enumeration date
07/06/2006
Last updated
11/29/2007
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