Healthcare Provider Details

I. General information

NPI: 1316944192
Provider Name (Legal Business Name): LAUREN K LARSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 REGENCY RD
LEXINGTON KY
40503-2954
US

IV. Provider business mailing address

280 PASADENA DR
LEXINGTON KY
40503-2925
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-1316
  • Fax: 859-276-1574
Mailing address:
  • Phone: 859-278-1316
  • Fax: 859-278-9896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number36246
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: