MEDICARE: LARRY VAN CARSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	0101039834	VA
2	207T00000X	Neurological Surgery Physician	20197	GA
3	207T00000X	Neurological Surgery Physician	25835	TN
4	207T00000X	Neurological Surgery Physician	01082907A	IN
5	207T00000X	Neurological Surgery Physician	14284	WV
6	207T00000X	Neurological Surgery Physician	2008-02090	NC
7	208200000X	Plastic Surgery Physician	01082907A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588764385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY VAN CARSON MD

Provider Business Mailing Address
First Line	:	PO BOX 95590
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-0590
Country	:	US
Telephone Number	:	801-784-0954
Fax Number	:	801-352-7976

Provider Business Practice Location Address
First Line	:	123 BAPTIST WAY
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2254
Country	:	US
Telephone Number	:	448-227-8478
Fax Number	:	448-227-2100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	06/11/2026

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Directions to “ LARRY VAN CARSON MD” Practice Location

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