MEDICARE: TAYLOR LARSON

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1447801428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR LARSON

Provider Business Mailing Address
First Line	:	PSC 479 BOX 243
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96269-0003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 479 BOX 243
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96269-0003
Country	:	US
Telephone Number	:	315-763-5415
Fax Number	:

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

Provider Enumeration Date	:	09/22/2019
Last Update Date	:	01/19/2026

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Directions to “ TAYLOR LARSON ” Practice Location

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