# BRUCE D LARSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1265470371
- **Gender:** Man
- **Credential:** PAC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PAC0257 | ND | Yes |

## Other

- **Enumeration date:** 06/02/2006
- **Last updated:** 02/19/2016

## 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 |