Individual
MR. LARRY MICHAEL OBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11197 W FAIRVIEW AVE, BOISE, ID 83713-7935
(208) 378-8011
(208) 322-8095
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6522
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-1099
ID
363LF0000X
Family Nurse Practitioner
PA11201
CA
Other
Enumeration date
08/05/2006
Last updated
07/08/2014
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