Individual
DR. MATTHEW JAMES LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1215 TOWN CENTRE DR, SUITE 200, EAGAN, MN 55123-1033
(651) 251-3300
(651) 255-3450
Mailing address
60 PLATO BLVD E, SUITE 270, SAINT PAUL, MN 55107-1827
(651) 209-1600
(651) 291-9169
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
46578
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0030001093
MEDICA
MN
01
—
070001049
MEDICARE PTAN
MN
01
—
0FE27LA
BLUE SHIELD
MN
01
—
P01199766
RAILROAD MEDICARE
MN
Enumeration date
04/19/2006
Last updated
10/02/2013
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