Individual
DR. JEFFREY J LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3320 N GRAND MILL LN, COEUR D ALENE, ID 83814-5689
(208) 765-9100
(208) 765-9103
Mailing address
3320 N GRAND MILL LN, COEUR D ALENE, ID 83814-5689
(208) 765-9100
(208) 765-9103
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
M-8677
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0172112
WASHINGTON L & I
—
01
—
205112900
OWCP
—
Enumeration date
10/23/2006
Last updated
07/23/2025
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