Individual
DR. LARESA G DEBOER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 S MAPLE ST, WACONIA, MN 55387-1752
(952) 442-2191
Mailing address
PO BOX 81, CHASKA, MN 55318-0081
(888) 398-3327
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
43130
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054M5DE
BCBS
—
01
—
1027863
PREFERRED ONE
—
01
—
140370
UCARE
—
01
—
39-01795
MEDICA EMERG
—
01
—
HP32799
HEALTH PARTNERS
—
Enumeration date
05/25/2006
Last updated
12/03/2007
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