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General NPI Number Information
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NPI Number | 1710097357
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Entity Type | Individual
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Provider Name | LEONARD JOHN LARSON II MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4810 STATE AVE WYANDOTTE URGENT CARE
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City | KANSAS CITY
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State | KS
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Zip | 66102-1748
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Country | US
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Telephone | 913-321-4567
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Fax | 913-321-6789
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Provider Business Mailing Address
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Address Line | 2330 SHAWNEE MISSION PKWY MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE 312
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City | WESTWOOD
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State | KS
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Zip | 66205-2005
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Country | US
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Telephone | 913-588-9000
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Fax | 913-588-9822
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 04-3170
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License Number State | KS
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