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NPI Code Detail

MEDICARE: DR. ROBERT LARSON D.P.M.

MEDICARE: DR. ROBERT LARSON D.P.M.
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
1213ES0103XFoot & Ankle Surgery PodiatristNV9604NV
2213ES0103XFoot & Ankle Surgery Podiatrist9604NV

General Provider Information

NPI Number : 1366532913
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT LARSON D.P.M.
Provider Business Mailing Address
First Line : 7245 W LA MADRE WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-5858
Country : US
Telephone Number : 702-653-3134
Fax Number : 702-653-2790
Provider Business Practice Location Address
First Line : 4701 N. LAS VEGAS BLVD.
Second Line :
City : N. LAS VEGAS
State : NV
Zip : 89191
Country : US
Telephone Number : 702-653-3134
Fax Number : 702-653-2790
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 07/08/2007

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