Individual
MR. RICHARD E LARSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
5290 MCNUTT ROAD, SANTA TERESA, NM 88008-1590
(505) 589-1144
(505) 589-2008
Mailing address
5290 MCNUTT ROAD, PO BOX 1590, SANTA TERESA, NM 88008-1590
(505) 589-1144
(505) 589-2008
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
N99PA22
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00120
BCBS OF NM
NM
Enumeration date
05/18/2006
Last updated
07/21/2022
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