Active NPI
Walter G. Larsen, M.D.
- Specialist
- Portland, OR
National Provider Identifier
1982670162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- OR 6013
- Practice address
- 1414 NW Northrup St
Suite 600
Portland, OR 97209-2798 - Phone
- (503) 223-3104
- Fax
- (503) 223-4619
- NPI assigned
- Feb 27, 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 |
|---|---|---|---|---|
| Specialist | 174400000X | OR 6013 | OR | Primary |
Addresses
Primary practice location
1414 NW Northrup St
Suite 600
Portland, OR 97209-2798
Mailing address
1414 NW Northrup St
Suite 600
Portland, OR 97209-2798
Phone (503) 223-3104
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OR 6013 | OR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279497600000",
"number": "1982670162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 NW NORTHRUP ST",
"address_2": "SUITE 600",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972092798",
"telephone_number": "503-223-3104",
"fax_number": "503-223-4619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 NW NORTHRUP ST",
"address_2": "SUITE 600",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972092798",
"telephone_number": "503-223-3104",
"fax_number": "503-223-4619"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "WALTER",
"middle_name": "G.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2010-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "OR 6013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.