Individual
ROBERT WAYNE LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1600 CREEKSIDE DR, STE 3100, FOLSOM, CA 95630-3444
(916) 983-8555
(916) 983-8568
Mailing address
1600 CREEKSIDE DR, STE 3100, FOLSOM, CA 95630-3444
(916) 983-8555
(916) 983-8568
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E2687
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E26870
—
CA
05
—
000E26872
—
CA
01
—
318089200
DEPT OF LABOR
—
01
—
480017653
RAILROAD MEDICARE
—
Enumeration date
10/11/2005
Last updated
09/06/2012
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