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General NPI Number Information
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NPI Number | 1801030234
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Entity Type | Individual
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Provider Name | PETER ASTRUP LARSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 808 OIL CREEK ROAD BOX 428
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City | NEWCASTLE
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State | WY
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Zip | 82701-0428
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Country | US
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Telephone | 307-746-2125
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Fax |
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Provider Business Mailing Address
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Address Line | 808 OIL CREEK ROAD BOX 428
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City | NEWCASTLE
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State | WY
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Zip | 82701-0428
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Country | US
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Telephone | 307-746-2125
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 22033
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2699A
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License Number State | WY
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