Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 2013019928 | MO |
Y | 208800000X | Urologist | 83826 | SC |
NPI | 1013166990 |
---|---|
Provider Name | Dr. Jeffrey A Larson |
First Address | Columbia, SC 29202-3174 |
Second Address | Anderson, SC 29621-1580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 12/08/2020 |