Individual
CHARLES BAYARD LARCOM IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
7491920
WI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
7491920
WI
207RP1001X
Pulmonary Disease Physician
Primary
7491920
WI
208D00000X
General Practice Physician
74919-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/05/2019
Last updated
07/18/2025
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