Larson, Mark W
Larson, Mark W is an individual health care provider with primary practice located at 716 E Manitoba Ave , Ellensburg WA 98926-3842. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Larson, Mark W can be contacted via phone (509) 925-3151.Contact Information
Primary practice address
716 E Manitoba Ave
Ellensburg WA 98926-3842
Phone: (509) 925-3151
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 2520900035733 | Washington |
Profile Details
| NPI number | 1194784090 |
|---|---|
| LBN Legal business name | Larson, Mark W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 20th, 2006 |
| Last updated | Mar 23rd, 2010 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194784090 | NPPES |
| Washington | MEDICAID | 8219073 |
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