Doctor Name: | DAVID E. LARSON |
NPI Number: | 1245395086 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 1077 |
Business Practice Address: | 9601 Townline Rd Minocqua, WI - 545489099 |
Business Phone Number: | 7153581000 |
Business Fax Number: | |
Mailing Address: | 1000 N Oak Ave, MARSHFIELD |
State: | WI |
Postal Code: | 544495703 |
Phone Number: | 7153875511 |
Fax Number: | |
NPI Enumeration Date: | 12/22/2006 |
NPI Last Update Date: | 06/07/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1077 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |