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NPI Code Detail

MEDICARE: BRIAN J LARSON MD

MEDICARE: BRIAN J LARSON MD
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
12085R0001XRadiation Oncology Physician11787AL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00462711OTHERALRAILROAD MEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10366100001OTHERALMC NSC
30366100001OTHERALCIGNA GOVERNMENT SERVICES PTAN

General Provider Information

NPI Number : 1861498370
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN J LARSON MD
Provider Business Mailing Address
First Line : 3485 INDEPENDENCE DR
Second Line :
City : HOMEWOOD
State : AL
Zip : 35209-5603
Country : US
Telephone Number : 205-414-4402
Fax Number : 205-414-4425
Provider Business Practice Location Address
First Line : 3485 INDEPENDENCE DR
Second Line :
City : HOMEWOOD
State : AL
Zip : 35209-5603
Country : US
Telephone Number : 205-414-4402
Fax Number : 205-414-4425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 09/28/2009

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