Basic Information
| Provider Information | |||||||||
| NPI: | 1427218270 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARRYMORE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | CHRISTIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 565 EUREKA WAY | ||||||||
| Address2: | |||||||||
| City: | SEQUIM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983825074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605820808 | ||||||||
| FaxNumber: | 3606832712 | ||||||||
| Practice Location | |||||||||
| Address1: | 565 EUREKA WAY | ||||||||
| Address2: | |||||||||
| City: | SEQUIM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983825074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605820808 | ||||||||
| FaxNumber: | 3606832712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2008 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 25621 | NE | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | MD61130459 | WA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 2189218 | 05 | WA | MEDICAID |