Individual
BRUCE D LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
819 MAIN ST, LISBON, ND 58054-4244
(701) 683-4134
(701) 683-4094
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 683-4134
(701) 683-4094
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0257
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0113759
MEDICA #
ND
01
—
0113760
MEDICA #
ND
01
—
0113761
MEDICA #
ND
01
—
137047
UCARE #
ND
01
—
1797235
AMERICA'S PPO/ARAZ #
ND
01
—
23227
NDBS #
ND
01
—
23228
NDBS #
ND
01
—
514S3LA
MNBS #
ND
01
—
514S4LS
MNBS #
ND
01
—
515S5LA
MNBS #
ND
05
—
798727700
—
ND
01
—
DA9061031057
PREFERRED ONE #
ND
01
—
HP38590
HEALTHPARTNERS #
ND
01
—
P00055624
RR MEDICARE #
ND
Enumeration date
06/02/2006
Last updated
02/19/2016
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