| Doctor Name: | DR. JOHN ROBERT LARSON |
| NPI Number: | 1215932173 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 01033673 |
| Business Practice Address: | 1724 W Plymouth St Bremen, IN - 465061940 |
| Business Phone Number: | 5745463649 |
| Business Fax Number: | 5745463952 |
| Mailing Address: | 1724 W Plymouth St, BREMEN |
| State: | IN |
| Postal Code: | 465061940 |
| Phone Number: | 5745463649 |
| Fax Number: | 5745463952 |
| NPI Enumeration Date: | 06/16/2005 |
| NPI Last Update Date: | 01/14/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VX0000X |
| License Number: | 01033673 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Obstetrics |
| Taxonomy Definition: | |