Individual
DR. PAUL RICHARD LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 W SOUTH AVE, CHEWELAH, WA 99019
(509) 935-8111
(509) 935-8402
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
(509) 944-9644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00037362
WA
207VX0000X
Obstetrics Physician
MD00037362
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129298
LABOR & INDUSTRIES ID #
WA
05
—
8241929
—
WA
01
—
CE9078
RAILROAD MEDICARE
WA
Enumeration date
09/25/2006
Last updated
06/16/2021
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