Individual
REBECCA J LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
751 N RUTLEDGE ST, SUITE 2300, SPRINGFIELD, IL 62702-4968
(217) 545-8000
(217) 545-4485
Mailing address
PO BOX 19644, SPRINGFIELD, IL 62794-9644
(217) 545-8000
(217) 545-4485
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
036-132957
IL
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
036-132957
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036132957
—
IL
Enumeration date
06/26/2008
Last updated
10/22/2020
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