Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | P6670 | TX |
Y | 207XS0106X | Orthopaedic Hand Surgeon | P6670 | TX |
NPI | 1144434242 |
---|---|
Provider Name | Timothy Brad Larson |
First Address | Denton, TX 76201-5144 |
Second Address | Denton, TX 76201-5144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 20/05/2021 |