Individual
JOB LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
278 VT ROUTE 149, WEST PAWLET, VT 05775-9798
(802) 645-0580
Mailing address
PSC 808 BOX 19, FPO, AE 09618-0001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042.0013562
VT
Other
Enumeration date
05/06/2015
Last updated
08/02/2023
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