Individual
PAUL LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
721 AMERICAN AVENUE SUITE 501, PHC BEHAVIORAL MEDICINE CENTER, WAUKESHA, WI 53188
(262) 928-2396
(262) 544-1213
Mailing address
721 AMERICAN AVENUE SUITE 501, PHC BEHAVIORAL MEDICINE CENTER, WAUKESHA, WI 53188
(262) 928-2396
(262) 544-1213
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
39093
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34096900
—
WI
Enumeration date
02/13/2006
Last updated
04/25/2012
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