Individual
ALAN WAYNE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15611 POMERADO RD, SUITE 500, POWAY, CA 92064-2425
(858) 487-2121
(858) 487-3321
Mailing address
15611 POMERADO RD, SUITE 500, POWAY, CA 92064-2425
(858) 487-2121
(858) 487-3321
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G39334
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G393340
—
CA
01
—
100002787
RAILROAD M EDICARE
CA
Enumeration date
08/08/2006
Last updated
12/01/2008
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