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General NPI Number Information
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NPI Number | 1144340712
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Entity Type | Individual
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Provider Name | TERRY LEE LARSEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 205 ORCHARD DR
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City | SISSETON
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State | SD
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Zip | 57262-2312
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Country | US
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Telephone | 605-698-4665
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Fax | 605-698-6401
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Provider Business Mailing Address
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Address Line | PO BOX 905
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-0905
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Country | US
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Telephone | 802-748-8141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 032.0066383
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License Number State | VT
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