| Doctor Name: | DR. CHARLES E LARSON |
| NPI Number: | 1184768129 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 26821 |
| Business Practice Address: | Flci W10237 Lake Emily Rd Fox Lake, WI - 549358525 |
| Business Phone Number: | 9209286958 |
| Business Fax Number: | 9209286951 |
| Mailing Address: | W4455 Overland Trl, FOND DU LAC |
| State: | WI |
| Postal Code: | 549358525 |
| Phone Number: | 9209249630 |
| Fax Number: | |
| NPI Enumeration Date: | 02/15/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 26821 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |