Provider Demographics
NPI:1003906959
Name:LARSON, ANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:1560 N 115TH STREET #207
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-520-5700
Mailing Address - Fax:206-668-1342
Practice Address - Street 1:1560 N 115TH ST STE 207
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8414
Practice Address - Country:US
Practice Address - Phone:206-668-1341
Practice Address - Fax:206-668-1342
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031080207RG0100X, 207RT0003X, 207RI0008X
TXN0912207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1003906959Medicaid
WA8948067Medicare PIN
TX126686802Medicaid
WA8212581Medicaid
AB00923Medicare ID - Type Unspecified