Individual
DOUGLAS STEVEN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
701 HEWITT BLVD, RED WING, MN 55066
(651) 267-5000
Mailing address
701 HEWITT BLVD, RED WING, MN 55066-2848
(651) 267-5000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12317
MN
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
3095
WI
Other
Enumeration date
07/07/2010
Last updated
10/09/2020
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