MEDICARE: MRS. VALERIE A. LARSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4884	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1402966	OTHER		AMERICAS PPO
2	4996052	OTHER	SD	WELLMARK BCBS OF SD
3	0108605	OTHER		MEDICA
4	57022A009	OTHER		TRICARE
5	0008142	OTHER	SD	WELLMARK BCBS OF SD
6	4884	OTHER	SD	DAKOTACARE
7	55F71LA	OTHER	MN	BCBS OF MN
8	AH9021028613	OTHER		PREFFERED ONE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	233740	OTHER		MIDLANDS CHOICE

General Provider Information

NPI Number	:	1124097027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE A. LARSON M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 8
Second Line	:
City	:	DELL RAPIDS
State	:	SD
Zip	:	57022-1208
Country	:	US
Telephone Number	:	605-428-5446
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 10TH STREET
Second Line	:
City	:	DELL RAPIDS
State	:	SD
Zip	:	57022-1208
Country	:	US
Telephone Number	:	605-428-5446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	06/03/2010

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Directions to “ MRS. VALERIE A. LARSON M.D.” Practice Location

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