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General NPI Number Information
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NPI Number | 1386966133
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Entity Type | Individual
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Provider Name | KYLE JAMES LARSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 353 FAIRMONT BLVD
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City | RAPID CITY
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State | SD
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Zip | 57701-7375
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Country | US
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Telephone | 605-755-5700
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Fax | 605-755-5766
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Provider Business Mailing Address
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Address Line | 353 FAIRMONT BLVD
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City | RAPID CITY
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State | SD
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Zip | 57701-7375
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Country | US
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Telephone | 605-755-5700
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Fax | 605-755-5766
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11595
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | 11595
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License Number State | SD
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