| Philip Robert Larson, RDN | |
|
19600 E Ross St # 4014, Tahlequah, OK 74464-0545 | |
| (534) 234-4114 | |
| Not Available |
| Full Name | Philip Robert Larson |
|---|---|
| Gender | Male |
| Speciality | Dietitian, Registered |
| Location | 19600 E Ross St # 4014, Tahlequah, Oklahoma |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568116309 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133V00000X | Dietitian, Registered | 2697 (Oklahoma) | Primary |
| Provider Name | Cherokee Nation |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1780692723 PECOS PAC ID: 5799698742 Enrollment ID: O20031106000628 |
| Mailing Address | Practice Location Address |
|---|---|
| Philip Robert Larson, RDN 19600 E Ross St # 4014, Tahlequah, OK 74464-0545 Ph: (539) 234-4114 | Philip Robert Larson, RDN 19600 E Ross St # 4014, Tahlequah, OK 74464-0545 Ph: (534) 234-4114 |
Tori Geasland, Dietitian Medicare: Medicare Enrolled Practice Location: 1321 W Red Oak St, Tahlequah, OK 74464 Phone: 918-457-9849 | |
Samuel Quinn Swenson, Dietitian Medicare: Not Enrolled in Medicare Practice Location: 710 Janet St, Tahlequah, OK 74464 Phone: 918-577-5780 | |
Sarah Hope Fitzgerald, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 3880 Highland Dr, Tahlequah, OK 74464 Phone: 985-290-8611 | |
Ms. Lavon Sue Lewis, L.D.R.D. Dietitian Medicare: Medicare Enrolled Practice Location: 712 Janet St, Tahlequah, OK 74464 Phone: 918-456-6230 Fax: 918-456-6230 | |
Mrs. Tonya Rae Swim, RD Dietitian Medicare: Medicare Enrolled Practice Location: 100 S Bliss Ave, Tahlequah, OK 74464 Phone: 918-458-3180 | |
Tera Beth Windham, RD LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 100 S Bliss Ave, Tahlequah, OK 74464 Phone: 918-458-3100 | |
Elizabeth Jo Havard, RDN, LD Dietitian Medicare: Medicare Enrolled Practice Location: 19600 E Ross St, Tahlequah, OK 74464 Phone: 539-234-1000 |