Individual
TRACEY D LARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4821 SW 9TH ST, DES MOINES, IA 50315-3802
(515) 262-8471
(515) 266-9783
Mailing address
4821 SW 9TH ST, DES MOINES, IA 50315-3802
(515) 262-8471
(515) 266-9783
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2955
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1155671
—
IA
Enumeration date
09/20/2006
Last updated
10/19/2007
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