Individual
JEAN M LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
417 STATE ST STE 121, BANGOR, ME 04401-6630
(207) 973-4266
(207) 973-5151
Mailing address
43 WHITING HILL RD STE 300, BREWER, ME 04412-1006
(207) 973-5042
(207) 973-5042
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME100673
FL
207RG0100X
Gastroenterology Physician
Primary
018950
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033206941
—
ME
05
—
280216300
—
FL
Enumeration date
10/10/2006
Last updated
02/28/2012
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