Healthcare Provider Details

I. General information

NPI: 1104864354
Provider Name (Legal Business Name): JOHN R LARSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 SIDNEY ST SUITE 203
BATESVILLE AR
72501-7203
US

IV. Provider business mailing address

PO BOX 2197
BATESVILLE AR
72503-2197
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-6155
  • Fax: 870-262-6152
Mailing address:
  • Phone: 870-262-6155
  • Fax: 870-262-6152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberE7818
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE-7818
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberE7818
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: