Individual
JEFFREY E LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2424 S 90TH ST, SUITE 500, WEST ALLIS, WI 53227-2455
(414) 328-8600
(414) 328-8686
Mailing address
19475 W NORTH AVE, STE 201, BROOKFIELD, WI 53045-4199
(262) 395-4163
(262) 395-4159
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
31144020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31597600
—
WI
01
—
CG1663
MEDICARE RAILROAD
WI
Enumeration date
10/25/2005
Last updated
12/10/2019
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