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General NPI Number Information
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NPI Number | 1609225960
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Entity Type | Individual
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Provider Name | DAVID LARSEN DO
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Gender | Male
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 705 E MARSHALL AVE STE 1002
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City | LONGVIEW
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State | TX
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Zip | 75601
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Country | US
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Telephone | 903-759-7200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846098
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City | DALLAS
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State | TX
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Zip | 75284-6098
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Country | US
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Telephone | 903-324-6400
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | BP10057146
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R7800
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License Number State | TX
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