Individual
RICHARD D. LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2215 PORTLAND AVE, LOUISVILLE, KY 40212-1033
(502) 774-8631
Mailing address
2215 PORTLAND AVE, LOUISVILLE, KY 40212-1033
(502) 774-8631
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27160
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64271604
—
KY
Enumeration date
09/08/2005
Last updated
03/10/2011
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