Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 52022 | CO |
N | 208000000X | Pediatrician | 52022 | CO |
NPI | 1659696540 |
---|---|
Provider Name | Dr. Austin Alexander Larson |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2010 |
Last Update Date | 17/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FL3750040 | DEA (01) | CO |