MEDICARE: ROBERT WAYNE LARSEN DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E2687	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	480017653	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	318089200	OTHER	DEPT OF LABOR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427046770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WAYNE LARSEN DPM

Provider Business Mailing Address
First Line	:	1600 CREEKSIDE DR
Second Line	:	STE 3100
City	:	FOLSOM
State	:	CA
Zip	:	95630-3444
Country	:	US
Telephone Number	:	916-983-8555
Fax Number	:	916-983-8568

Provider Business Practice Location Address
First Line	:	1600 CREEKSIDE DR
Second Line	:	STE 3100
City	:	FOLSOM
State	:	CA
Zip	:	95630-3444
Country	:	US
Telephone Number	:	916-983-8555
Fax Number	:	916-983-8568

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	09/06/2012

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Directions to “ ROBERT WAYNE LARSEN DPM” Practice Location

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