Healthcare Provider Details

I. General information

NPI: 1447540521
Provider Name (Legal Business Name): JOSHUA M LARSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 1ST ST STE. 302
DULUTH MN
55805-2201
US

IV. Provider business mailing address

920 E 1ST ST STE. 302
DULUTH MN
55805-2201
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-6050
  • Fax: 218-249-6055
Mailing address:
  • Phone: 218-249-6050
  • Fax: 218-249-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number56363
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: