DR. PAUL RICHARD LARSEN (NPI# 1720189749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720189749 |
| Entity Type | Individual |
| Full Name | DR. PAUL RICHARD LARSEN |
| Credential | MD |
| Practice Address |
100 W South Ave Chewelah WA 99019 |
| Mailing Address |
Po Box 421 Liberty Lake WA 99019-0421 |
| Practice Telephone | 5099358111 |
| Practice Fax Number | 5099358402 |
| Mailing Telephone | 8667472455 |
| Mailing Fax Number | 5099449644 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2014-10-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD00037362 | WA | Allopathic & Osteopathic Physicians |
| N | 207VX0000X |
Obstetrics & Gynecology Specialization: Obstetrics |
MD00037362 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 8241929 | 05 | |
| WA | LABOR & INDUSTRIES ID # | 129298 | 01 |
| WA | RAILROAD MEDICARE | CE9078 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427315423 | Paul Larsen | Internal Medicine | 1027 Bellevue Ave Ste 200, Saint Louis, MO 63117-1851 | 2012-04-13 |
| 1881927291 | Paul A. Larsen | Marriage & Family Therapist | 17662 Irvine Blvd Ste 11, Tustin, CA 92780-3133 | 2009-09-16 |
| 1346369907 | Paul Larsen | Hearing Instrument Specialist | 2 Route 37 W, Dover Mall, Toms River, NJ 08753-6588 | 2007-03-28 |
| 1184742264 | Paul Christian Larsen | Dentist | 395 E 500 S, Bountiful, UT 84010-4924 | 2007-03-27 |
| 1669474110 | Paul D. Larsen | Specialist | Emile 42nd St, Omaha, NE 68198-0001 | 2005-08-15 |
| 1235439621 | Paul Lorenzo Larsen | Physician Assistant | 907 Georgiana St, Port Angeles, WA 98362-3911 | 2010-11-01 |
| 1003058504 | Paul R Larsen | Case Manager/Care Coordinator | 327 College Ave, Santa Rosa, CA 95401-5117 | 2009-03-30 |
| 1609955798 | Paul Larsen | Dentist | 165 W University Dr, Mishawaka, IN 46545-1199 | 2006-11-02 |
| Street Address |
100 W SOUTH AVE |
| City | CHEWELAH |
| State | WA |
| Zip Code | 99019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124438338 | Caleb Christman Holtzer | Family Medicine | 100 W South Ave, Chewelah, WA 99109-9684 | 2014-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194201533 | Lorena Margaret De La Rosa | Nurse Practitioner | 22820 E Appleway Ave Ste A, Liberty Lake, WA 99019 | 2018-07-18 |
| 1831641570 | Shirla Underwood | Spec/Tech, Cardiovascular | 3705 S Molter Rd, Liberty Lake, WA 99019 | 2016-10-28 |
| 1215393079 | Samuel Lionel Nelson | Chiropractor | 23801 East Appleway Ave, #110, Liberty Lake, WA 99019 | 2016-01-11 |
| 1841627601 | Noland Peterdy | Pharmacist | 1423 N Molter 727, Liberty Lake, WA 99019 | 2013-10-10 |
| 1043559446 | Phillip Wayne Harris | Reflexologist | E 23505 Appleway, Liberty Lake, WA 99019 | 2013-02-05 |
| 1710231766 | Mark Autrey | Pharmacist | 23010 E Settler Drive, Spokane, WA 99019 | 2012-10-30 |
| 1982971107 | Michele Ladd | Dental Hygienist | 22826 East Clearwater Lane, Liberty Lake, WA 99019 | 2011-11-17 |
| 1467689166 | Drostan Gregg Baker | Family Medicine | 2207 N Molter Rd Ste 203, Liberty Lake, WA 99019 | 2009-06-19 |
| 1619117959 | Joline Marie Messina | Behavioral Analyst | 1324 N Liberty Lake Rd # 193, Liberty Lake, WA 99019 | 2009-02-26 |
| 1144427964 | J. Evans, Dmd, P.s. | Dentist | 1327 N Stanford Lane, Suite B, Liberty Lake, WA 99019 | 2007-06-27 |
| Find all providers in zip 99019 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619268281 | Providence Physician Services Co | Family Medicine | 100 W. South Ave Chewelah, Chewelah, WA 99109 | 2011-04-29 |
| 1528128907 | Kimberlyn Ann Johnstone | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2006-12-08 |
| 1346325750 | Thomas John Boone | Family Medicine | 410 E King Street, Chewelah, WA 99109-0137 | 2006-10-25 |
| 1124438338 | Caleb Christman Holtzer | Family Medicine | 100 W South Ave, Chewelah, WA 99109-9684 | 2014-04-28 |
| 1063632388 | Chewelah Associated Physicians | Family Medicine | 410 E King St, Chewelah, WA 99109 | 2007-04-27 |
| 1316167638 | Chewelah Associated Physicians | Family Medicine | 410 E King St, Chewelah, WA 99109 | 2007-04-27 |
| 1104971365 | Chewelah Associated Physicians Ps | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2007-01-25 |
| 1447310347 | James Gregory Sisco | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2006-12-11 |
| 1821158734 | Robin Nelson Moyer | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2006-12-11 |
| 1477654416 | Maja Zugec | Family Medicine | 518 E Clay Ave, Chewelah, WA 99109-8947 | 2006-09-25 |
| Find all providers in CHEWELAH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.