Active NPI
George Martin Larson III, D.O.
- Family Medicine Physician
- Springfield, OR
National Provider Identifier
1972677102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DO 08155
- Practice address
- 21 Hayden Bridge Way
Springfield, OR 97477-1305 - Phone
- (541) 741-1226
- Fax
- (541) 741-0673
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DO 08155 | OR | Primary |
Addresses
Primary practice location
21 Hayden Bridge Way
Springfield, OR 97477-1305
Mailing address
21 Hayden Bridge Way
Springfield, OR 97477-1305
Phone (541) 741-1226
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109298 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO 08155 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191542400000",
"number": "1972677102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 HAYDEN BRIDGE WAY",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974771305",
"telephone_number": "541-741-1226",
"fax_number": "541-741-0673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 HAYDEN BRIDGE WAY",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974771305",
"telephone_number": "541-741-1226",
"fax_number": "541-741-0673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "GEORGE",
"middle_name": "MARTIN",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2007-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "DO 08155",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "109298",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.