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General NPI Number Information
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NPI Number | 1487699013
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Entity Type | Individual
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Provider Name | ERIC MOWATT-LARSSEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 977 PACIFIC ST STE B
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City | MONTEREY
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State | CA
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Zip | 93940-4400
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Country | US
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Telephone | 831-646-8346
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Fax | 831-646-8346
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Provider Business Mailing Address
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Address Line | 977 PACIFIC ST STE B
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City | MONTEREY
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State | CA
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Zip | 93940-4400
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Country | US
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Telephone | 831-646-8346
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Fax | 831-646-8346
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0101230922
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | C55209
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License Number State | CA
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