Individual
BRIAN J LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNIM
Contact information
Practice address
905 W ST ANTHONY AVE, EFFINGHAM, IL 62401
(217) 342-7256
Mailing address
PO BOX 1527, EFFINGHAM, IL 62401-1527
(217) 342-7256
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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