Healthcare Provider Details

I. General information

NPI: 1124097027
Provider Name (Legal Business Name): VALERIE A. LARSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 10TH STREET
DELL RAPIDS SD
57022-1208
US

IV. Provider business mailing address

P.O. BOX 8
DELL RAPIDS SD
57022-1208
US

V. Phone/Fax

Practice location:
  • Phone: 605-428-5446
  • Fax:
Mailing address:
  • Phone: 605-428-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4884
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: