| Doctor Name: | DR. DANIEL A LARSON |
| NPI Number: | 1902068497 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 0011619845 |
| Business Practice Address: | 301 Fisher St. 81 Mdg/sgcxn Keesler Afb, MS - 395342519 |
| Business Phone Number: | 2283760066 |
| Business Fax Number: | |
| Mailing Address: | 301 Fisher Street, 81 Mdg/sgcxn, Keesler Afb APO |
| State: | AA |
| Postal Code: | 395342519 |
| Phone Number: | 2283760420 |
| Fax Number: | |
| NPI Enumeration Date: | 06/26/2008 |
| NPI Last Update Date: | 04/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 0011619845 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |