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Individual
DR. JAN MARIE LARSON
Active
Individual
DR. JAN MARIE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME69977
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080081655
RAILROAD MEDICARE
FL
05
—
261525800
—
FL
01
—
28880
BLUECROSS/BLUESHIELD
FL
Enumeration date
10/13/2005
Last updated
08/16/2007
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