Individual
DR. DAVID L LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8700 WATERTOWN PLANK ROAD, WISCONSIN ATHLETIC CLUB BLDG, MILWAUKEE, WI 53226
(414) 805-3666
Mailing address
8700 W WATERTOWN PLANK RD, WISCONSIN ATHLETIC CLUB BUILDING, MILWAUKEE, WI 53226-3595
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
27404
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30711500
—
WI
Enumeration date
05/12/2006
Last updated
07/08/2007
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