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General NPI Number Information
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NPI Number | 1649391772
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Entity Type | Organization
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Legal Business Name | ERIC W. LARSON, M.D., PLLC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6525 DREW AVE S
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City | EDINA
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State | MN
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Zip | 55435-2103
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Country | US
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Telephone | 952-920-6748
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Fax | 952-920-3863
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Provider Business Mailing Address
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Address Line | 6525 DREW AVE S
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City | EDINA
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State | MN
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Zip | 55435-2103
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Country | US
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Telephone | 952-920-6748
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Fax | 952-920-3863
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. BEV KRIEG
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Credential |
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Telephone | 952-920-6825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 28533
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License Number State | MN
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