| Doctor Name: | BRIAN J LARSON |
| NPI Number: | 1083836639 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CNIM |
| License Number: | |
| Business Practice Address: | 905 W St Anthony Ave Effingham, IL - 62401 |
| Business Phone Number: | 2173427256 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1527, EFFINGHAM |
| State: | IL |
| Postal Code: | 624011527 |
| Phone Number: | 2173427256 |
| Fax Number: | |
| NPI Enumeration Date: | 05/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246ZE0600X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | Electroneurodiagnostic |
| Taxonomy Definition: | |