Individual
DR. DAVID LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
655 LEXINGTON AVE, JACKSON, TN 38301-5075
(731) 215-2500
(731) 300-0307
Mailing address
655 LEXINGTON AVE, JACKSON, TN 38301-5075
(731) 215-2500
(731) 300-0307
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD0000009731
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000009028
TLC
TN
01
—
0017809
BLUE CROSS BLUE SHIELD
TN
01
—
080099502
RAILROAD MEDICARE
TN
05
—
3189319
—
TN
01
—
4277358
AETNA
TN
01
—
744524
FIRST HEALTH
TN
Enumeration date
10/03/2006
Last updated
03/17/2018
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