Individual
GREGORY S LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1008 MINNEQUA AVE, PUEBLO, CO 81004-3733
(719) 557-4221
(719) 557-3834
Mailing address
PO BOX 911057, DENVER, CO 80291-1057
(719) 557-4221
(719) 557-3834
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
41504
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52735567
—
CO
Enumeration date
06/20/2005
Last updated
07/07/2015
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