Individual
DR. SCOTT ALAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
305 E JEFFERSON ST, BOISE, ID 83712-6231
(208) 381-7370
(208) 381-6911
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
34581
IA
207W00000X
Ophthalmology Physician
52876571205
UT
207W00000X
Ophthalmology Physician
Primary
8961062
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0079679
—
UT
05
—
100501869
—
UT
01
—
107018826102
IHC TIN 876151902
UT
05
—
1119924
—
UT
05
—
120085200
—
UT
01
—
12463
U HEALTH PLANS
UT
01
—
214773
ALTIUS 876151902
UT
01
—
52876571200001
BCBS TIN 876151902
UT
01
—
73587
PEHP TIN 876151902
UT
01
—
756072
DMBA TIN 876151902
UT
05
—
806733700
—
UT
05
—
D8294
—
UT
01
—
TPRA07668
MOLINA TIN 876151902
UT
Enumeration date
05/17/2006
Last updated
10/24/2024
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