Boyd Eric Larson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

ML1456587 Issued in ID

Practice address

740 S Woodruff Ave
Idaho Falls, ID 83401-5285

Phone

(208) 542-9111

Fax

(208) 542-9114

NPI assigned

Oct 17, 2006

Last updated

Feb 10, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265760000000",
    "number": "1245310846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 LANE 12",
            "city": "LOVELL",
            "state": "WY",
            "postal_code": "82431",
            "telephone_number": "307-548-5200",
            "fax_number": "307-548-5224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015285",
            "telephone_number": "208-542-9111",
            "fax_number": "208-542-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "BOYD",
        "middle_name": "ERIC",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2010-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "ML1456587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Lanham
• Brandon Leon Larsen, PA-C
• Matthew F Larsen, DO
• Paul Lorenzo Larsen, PA-C
• Steven J. Larsen, FAGD DDS
• Brandy Lee Larson, FNP
• Gracie Larson
• Ryan Larson
• Tyler J. Larson, DPT
• Kari Anne Lasco-Sanders, DPT

• Medical Physician Assistant in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.