Healthcare Provider Details

I. General information

NPI: 1821013962
Provider Name (Legal Business Name): LANCE G LARSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E HERNDON AVE
FRESNO CA
93720-3309
US

IV. Provider business mailing address

1630 E HERNDON AVE
FRESNO CA
93720-3391
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-3000
  • Fax:
Mailing address:
  • Phone: 559-256-5200
  • Fax: 559-256-5376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA88814
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA88814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: