| David P Larson, Md, Llc | |
|
16043 Sw Waxwing Way Beaverton OR 97007-8362 | |
| (503) 719-2250 | |
| (503) 268-1210 |
| Full Name | David P Larson, Md, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 16043 Sw Waxwing Way, Beaverton, Oregon |
| Authorized Official Name and Position | David Paddock Larson (PRESIDENT/PHYSICIAN) |
| Authorized Official Contact | 5037192250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David P Larson, Md, Llc 16043 Sw Waxwing Way Beaverton OR 97007-8362 Ph: (503) 719-2250 | David P Larson, Md, Llc 16043 Sw Waxwing Way Beaverton OR 97007-8362 Ph: (503) 719-2250 |
| NPI Number | 1497306468 |
|---|---|
| Provider Enumeration Date | 09/21/2019 |
| Last Update Date | 04/16/2020 |
| Medicare PECOS PAC ID | 5092149260 |
|---|---|
| Medicare Enrollment ID | O20191220000942 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497306468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | David P Larson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992798599 PECOS PAC ID: 4688608565 Enrollment ID: I20090515000113 |
| Provider Name | Jennifer Ruth Quartermaine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295332252 PECOS PAC ID: 6901217488 Enrollment ID: I20211104002436 |
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