Individual
DR. WALLACE K LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4105 BRIARGATE PARKWAY, SUITE 300, COLORADO SPRINGS, CO 80920-3487
(719) 473-3332
(719) 368-6878
Mailing address
4105 BRIARGATE PARKWAY, SUITE 300, COLORADO SPRINGS, CO 80920-3487
(719) 473-3332
(719) 368-6878
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
CO25317
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01253178
—
CO
Enumeration date
01/19/2006
Last updated
01/21/2015
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