Dr. Charles E Larson
Family Doctor - Adult Medicine
Flci W10237 Lake Emily Rd
Fox Lake
, Wisconsin 54935-8525
Dr. Charles E Larson
Family Doctor - Adult Medicine
Flci W10237 Lake Emily Rd
Fox Lake
, Wisconsin 54935-8525
(920) 924-9630
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About
Features
Specialties
- Family Doctor - Adult Medicine
Languages spoken
- English
Location
First Address
- Dr. Charles E Larson
- W4455 Overland Trl
- Fond Du Lac, WI
- Zip : 54935-8525
- Phone : (920) 924-9630
Second Address
- Dr. Charles E Larson
- Flci W10237 Lake Emily Rd
- Fox Lake, WI
- Zip : 54935-8525
- Fax : (920) 928-6951
- Phone : (920) 928-6958
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QA0505X | Family Doctor - Adult Medicine | 26821 | WI |
National Provider Identifier
| NPI | 1184768129 |
|---|---|
| Provider Name | Dr. Charles E Larson |
| First Address | Fond Du Lac, WI 54935-8525 |
| Second Address | Fox Lake, WI 54935-8525 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/02/2007 |
| Last Update Date | 08/07/2007 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.