Individual provider Active NPI

Larsson Gepford, DO

  • Student in an Organized Health Care Education/Training Program
  • Portland, OR
National Provider Identifier
1104764240
Registry record updated Mar 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1015 NW 22ND Ave
Portland, OR 97210-3025
Phone
(503) 413-7711
Fax
(503) 413-6892
NPI assigned
Mar 23, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1015 NW 22ND Ave
Portland, OR 97210-3025

Mailing address

12801 Indian School Rd NE Apt 1806
Albuquerque, NM 87112-4776
Phone (360) 903-9989

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260518003949 OR Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 2769951839

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1774224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774224000000",
    "number": "1104764240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12801 INDIAN SCHOOL RD NE APT 1806",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871124776",
            "telephone_number": "360-903-9989",
            "fax_number": "503-413-6892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-413-7711",
            "fax_number": "503-413-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEPFORD",
        "first_name": "LARSSON",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-03-23",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.