Individual
JACQUELINE KAY LARSON
Active
Individual
JACQUELINE KAY LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
ME124534
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101153100
—
FL
01
—
76LDO
BLUE CROSS BLUE SHIELD
FL
Enumeration date
10/10/2012
Last updated
04/24/2024
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