Healthcare Provider Details

I. General information

NPI: 1861498370
Provider Name (Legal Business Name): BRIAN J LARSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 INDEPENDENCE DR
HOMEWOOD AL
35209-5603
US

IV. Provider business mailing address

3485 INDEPENDENCE DR
HOMEWOOD AL
35209-5603
US

V. Phone/Fax

Practice location:
  • Phone: 205-414-4402
  • Fax: 205-414-4425
Mailing address:
  • Phone: 205-414-4402
  • Fax: 205-414-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number11787
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: