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Individual
JEFFREY E LARSON
Active
Individual
JEFFREY E LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
31144020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31597600
—
WI
01
—
CG1663
MEDICARE RAILROAD
WI
Enumeration date
10/25/2005
Last updated
12/10/2019
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