Individual
PETER RICHARD LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
5803 NEAL AVE N, OAK PARK HEIGHTS, MN 55082-2177
(651) 439-8807
(651) 439-0232
Mailing address
5803 NEAL AVE N, OAK PARK HEIGHTS, MN 55082-2177
(651) 439-8807
(651) 439-0232
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1424-23
WI
363A00000X
Physician Assistant
Primary
9658
MN
363AS0400X
Surgical Physician Assistant
9658
MN
Other
Enumeration date
03/29/2006
Last updated
08/26/2021
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