Individual
EVAN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1100 BRIDGEWOOD DR STE 102, FORT WORTH, TX 76112-0808
(817) 966-7000
Mailing address
1100 BRIDGEWOOD DR STE 102, FORT WORTH, TX 76112-0808
(817) 966-7000
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1001565
TX
Other
Enumeration date
05/05/2020
Last updated
05/05/2020
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