Individual
DR. DOUGLAS GLEN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2020 PALOMINO LN, #100, LAS VEGAS, NV 89106-4842
(702) 759-8600
Mailing address
2020 PALOMINO LN, #100, LAS VEGAS, NV 89106-4842
(702) 759-8600
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
15305
NV
2085R0202X
Diagnostic Radiology Physician
Primary
MD172183
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003064999
—
CA
01
—
P01352399
RR DR
NV
01
—
P01418514
RR MEDICARE DRS
NV
Enumeration date
09/04/2008
Last updated
10/03/2016
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