Individual
GREGORY LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
550 E COLORADO BLVD, SPEARFISH, SD 57783-2776
(605) 717-8860
Mailing address
550 E COLORADO BLVD, SPEARFISH, SD 57783-2776
(605) 717-8860
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1039
SD
Other
Enumeration date
05/26/2016
Last updated
05/26/2016
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