Dr. John Robert Larson
Family Doctor Obstetrician
1724 W Plymouth St
Bremen
, Indiana 46506-1940
Dr. John Robert Larson
Family Doctor Obstetrician
1724 W Plymouth St
Bremen
, Indiana 46506-1940
(574) 546-3952
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About
Features
Specialties
- Family Doctor
- Obstetrician
Languages spoken
- English
Location
First Address
- Dr. John Robert Larson
- 1724 W Plymouth St
- Bremen, IN
- Zip : 46506-1940
- Fax : (574) 546-3952
- Phone : (574) 546-3649
Second Address
- Dr. John Robert Larson
- 1724 W Plymouth St
- Bremen, IN
- Zip : 46506-1940
- Fax : (574) 546-3952
- Phone : (574) 546-3649
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207Q00000X | Family Doctor | 01033673 | IN |
| N | 207VX0000X | Obstetrician | 01033673 | IN |
National Provider Identifier
| NPI | 1215932173 |
|---|---|
| Provider Name | Dr. John Robert Larson |
| First Address | Bremen, IN 46506-1940 |
| Second Address | Bremen, IN 46506-1940 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 16/06/2005 |
| Last Update Date | 14/01/2010 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000000296642 | ANTHEM BCBS (01) | IN |
| 0004619574 | AETNA (01) | IN |
| 100468970B | (05) | IN |
| 371199381 | TRICARE (01) | IN |
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.