Doctor Name: | DAVID C LARSEN |
NPI Number: | 1235125204 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | 737-25 |
Business Practice Address: | 311 Elm St Woodruff, WI - 545689149 |
Business Phone Number: | 7156349023 |
Business Fax Number: | 7156349935 |
Mailing Address: | 10640 Hayward Ct, HAYWARD |
State: | WI |
Postal Code: | 548436456 |
Phone Number: | 7156349023 |
Fax Number: | 7156349935 |
NPI Enumeration Date: | 09/23/2005 |
NPI Last Update Date: | 05/26/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0131X |
License Number: | 737-25 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot Surgery |
Taxonomy Definition: |