Individual
DR. JOHN ROBERT LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1724 W PLYMOUTH ST, BREMEN, IN 46506-1940
(574) 546-3649
(574) 546-3952
Mailing address
1724 W PLYMOUTH ST, BREMEN, IN 46506-1940
(574) 546-3649
(574) 546-3952
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01033673
IN
207VX0000X
Obstetrics Physician
01033673
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000296642
ANTHEM BCBS
IN
01
—
0004619574
AETNA
IN
05
—
100468970B
—
IN
01
—
371199381
TRICARE
IN
Enumeration date
06/16/2005
Last updated
01/14/2010
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