NPIMap

Organization Active NPI

Larry D Iversen MD LTD PS

  • Specialist
  • Bremerton, WA
National Provider Identifier
1295854123
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD00012070 Issued in WA
Legal business name
LARRY D IVERSEN MD LTD PS
Practice address
840 Callahan Dr
Suite C
Bremerton, WA 98310-3378
Phone
(360) 479-2525
Fax
(360) 479-0877
NPI assigned
Mar 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

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

Authorized official

Name
Larry D Iversen, M.D.
Title
Owner
Phone
(360) 479-2525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MD00012070 WA Primary

Addresses

Primary practice location

840 Callahan Dr
Suite C
Bremerton, WA 98310-3378

Mailing address

840 Callahan Dr
Suite C
Bremerton, WA 98310-3378
Phone (360) 479-2525

National Provider Directory

National Provider Directory

Locations

840 Callahan Dr
Ste C
Bremerton, WA 98310
Phone (360) 479-2525

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1295854123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 CALLAHAN DR",
            "address_2": "SUITE C",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983103378",
            "telephone_number": "360-479-2525",
            "fax_number": "360-479-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 CALLAHAN DR",
            "address_2": "SUITE C",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983103378",
            "telephone_number": "360-479-2525",
            "fax_number": "360-479-0877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY D IVERSEN MD LTD PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "IVERSEN",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-479-2525",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "MD00012070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bremerton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; 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.