1932193737 NPI number — DR. RAYMOND LLOYD LARSEN M.D.

Table of content: DR. RAYMOND LLOYD LARSEN M.D. (NPI 1932193737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932193737 NPI number — DR. RAYMOND LLOYD LARSEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSEN
Provider First Name:
RAYMOND
Provider Middle Name:
LLOYD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932193737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 10TH ST SE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58401-5980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-252-9020
Provider Business Mailing Address Fax Number:
701-252-2209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 10TH ST SE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401-5980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-252-9020
Provider Business Practice Location Address Fax Number:
701-252-2209
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  3722 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 791181009 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 1462502 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAR803722 . This is a "ND VISION SERVICES BCBS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 521001 . This is a "PREFERRED ONE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: N1441 . This is a "BCBS ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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