| Doctor Name: | GARY LEE LARSON |
| NPI Number: | 1023260098 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | R017398 |
| Business Practice Address: | Unit 45013 Usag-j, Box 3257 Apo, AP - 963385013 |
| Business Phone Number: | 3152634016 |
| Business Fax Number: | |
| Mailing Address: | Unit 45013, Usag-j, Box 3257 APO |
| State: | AP |
| Postal Code: | 963385013 |
| Phone Number: | 3152634016 |
| Fax Number: | |
| NPI Enumeration Date: | 10/21/2008 |
| NPI Last Update Date: | 10/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP2201X |
| License Number: | R017398 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Ambulatory Care |
| Taxonomy Definition: | |