NPI 1003211103

Tyler Roth Larson, PAC

Practitioner Physician Assistant Sweet Home, OR

Practice location

Address: 1289 49th Ave, Sweet Home, OR 97386
Phone: (541) 451-6250
Mailing address: PO Box 1189, Corvallis, OR 97339-1189

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence PA201515 (OR)

Other Physician Assistant providers in Oregon →

Registry record

NPI: 1003211103
Entity type: Individual
Sex (as registered): Male
NPI issued: 31 Oct 2014
Record last updated: 11 Jun 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.