Larry Michael Oborn, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-1099 Issued in ID

Practice address

11197 W Fairview Ave
Boise, ID 83713-7935

Phone

(208) 378-8011

Fax

(208) 322-8095

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404777600000",
    "number": "1942219233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191050",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837191050",
            "telephone_number": "208-955-6522",
            "fax_number": "208-955-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11197 W FAIRVIEW AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837137935",
            "telephone_number": "208-378-8011",
            "fax_number": "208-322-8095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBORN",
        "first_name": "LARRY",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2014-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "PA11201",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-1099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oasis Medical Center LLC
• OB-GYN Center PA
• Ericka Obaitek
• Delaney Breanne Obaldia, MA, LPC
• Jennifer Obenshain, LCSW
• Darin J Obrien, CRNA
• Timothy Tracy Obrien, DDS, MD
• Kelly M Obringer, SLP
• Occupational Health Centers of Idaho LLC
• Lindsey Elizabeth Ochoa, PA-C

• Medical Physician Assistant in Boise, ID
• Providers in Boise, 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 Jul 8, 2014; 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.