Organization
TIMBER VALLEY MEDICAL CLINIC P C
Active
Other names
Timber Valley Family Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE MARTIN LARSON III D.O. (CORPORATION PRESIDENT)
(541) 741-1226
Entity
Organization
Contact information
Practice address
21 HAYDEN BRIDGE WAY, SPRINGFIELD, OR 97477-1305
(541) 741-1226
(541) 714-0673
Mailing address
21 HAYDEN BRIDGE WAY, SPRINGFIELD, OR 97477-1305
(541) 741-1226
(541) 714-0673
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO 08511
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240511
—
OR
01
—
CJ9204
RAILROAD MEDICARE
OR
Enumeration date
11/14/2006
Last updated
04/20/2008
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