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Individual
BRUCE D LARSON
Active
Individual
BRUCE D LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0257
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0113759
MEDICA #
ND
01
—
0113760
MEDICA #
ND
01
—
0113761
MEDICA #
ND
01
—
137047
UCARE #
ND
01
—
1797235
AMERICA'S PPO/ARAZ #
ND
01
—
23227
NDBS #
ND
01
—
23228
NDBS #
ND
01
—
514S3LA
MNBS #
ND
01
—
514S4LS
MNBS #
ND
01
—
515S5LA
MNBS #
ND
05
—
798727700
—
ND
01
—
DA9061031057
PREFERRED ONE #
ND
01
—
HP38590
HEALTHPARTNERS #
ND
01
—
P00055624
RR MEDICARE #
ND
Enumeration date
06/02/2006
Last updated
02/19/2016
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