Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | IL | |
Y | 111NI0900X | Internist | IL |
NPI | 1003096140 |
---|---|
Provider Name | Dr. Dennis P Larson |
First Address | Belleville, IL 62221-7813 |
Second Address | Belleville, IL 62221-7813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2007 |
Last Update Date | 06/11/2007 |