Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 737-25 | WI |
Y | 222Z00000X | Podiatrist | 737-25 | WI |
N | 213ES0131X | Foot Surgery | 737-25 | WI |
NPI | 1235125204 |
---|---|
Provider Name | David C Larsen |
First Address | Lake Tomahawk, WI 54539-9110 |
Second Address | Woodruff, WI 54568-9149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 23/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43222700 | (05) | WI |
CG4176 | RAILROAD MEDICARE (01) | WI |
U63277 | (02) |