Individual
DR. LARRY R. NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 COOKS HILL RD, CENTRALIA, WA 98531-9072
(360) 736-0713
(360) 330-8680
Mailing address
1401 MARVIN RD NE, SUITE 307 PMB 266, LACEY, WA 98516-5709
(360) 491-5055
(360) 491-5890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
252-9 0013431
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14818
L&I WORKERS COMP
WA
05
—
1625003
—
WA
01
—
L00240
BLUE CROSS/BLUE SHIELD
WA
Enumeration date
07/17/2006
Last updated
07/09/2007
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