Larson, Jeremy Todd

Larson, Jeremy Todd is an individual health care provider with primary practice located at 1818 E Rezanof Dr , Kodiak AK 99615. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Larson, Jeremy Todd can be contacted via phone (907) 486-6065.

Contact Information

Primary practice address
1818 E Rezanof Dr Kodiak AK 99615
Phone: (907) 486-6065
Fax: (907) 486-2248
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 4934 Alaska
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 44523 Washington

Profile Details

NPI number 1548366891
LBN Legal business name Larson, Jeremy Todd
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2006
Last updated Oct 4th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548366891 NPPES
Washington MEDICAID 8419657

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