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General NPI Number Information
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NPI Number | 1427046770
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Entity Type | Individual
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Provider Name | ROBERT WAYNE LARSEN DPM
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Gender | Male
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 1600 CREEKSIDE DR STE 3100
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City | FOLSOM
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State | CA
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Zip | 95630-3444
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Country | US
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Telephone | 916-983-8555
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Fax | 916-983-8568
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Provider Business Mailing Address
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Address Line | 1600 CREEKSIDE DR STE 3100
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City | FOLSOM
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State | CA
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Zip | 95630-3444
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Country | US
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Telephone | 916-983-8555
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Fax | 916-983-8568
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E2687
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License Number State | CA
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