Individual
JOHN R LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1215 SIDNEY ST, SUITE 203, BATESVILLE, AR 72501-7203
(870) 262-6155
(870) 262-6152
Mailing address
PO BOX 2197, BATESVILLE, AR 72503-2197
(870) 262-6155
(870) 262-6152
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
E-7818
AR
207LP2900X
Pain Medicine (Anesthesiology) Physician
E7818
AR
208VP0014X
Interventional Pain Medicine Physician
Primary
E7818
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195965001
—
AR
01
—
264659YMPR
MEDICARE
AR
01
—
51281
BLUE CROSS BLUE SHIELD
AR
01
—
E-7818
STATE LICENSE
AR
Enumeration date
06/02/2006
Last updated
05/14/2024
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