Provider Demographics
NPI:1861794547
Name:LAROUCHE, JANE MARGARET (DO)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARGARET
Last Name:LAROUCHE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:MARGARET
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:2250 S WOODWORTH LOOP STE 202
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7457
Practice Address - Country:US
Practice Address - Phone:907-761-5800
Practice Address - Fax:907-761-5801
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1104552084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1648401Medicaid