Provider Demographics
NPI:1053570127
Name:LARWICK, DEREK (LMT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:LARWICK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 VALLEY RIVER WAY
Mailing Address - Street 2:106
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2127
Mailing Address - Country:US
Mailing Address - Phone:541-344-3689
Mailing Address - Fax:
Practice Address - Street 1:1011 VALLEY RIVER WAY
Practice Address - Street 2:106
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2127
Practice Address - Country:US
Practice Address - Phone:541-344-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist