Individual
LARRY A MATHISON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2200 COMMERCE BLVD, MOUND, MN 55364-1547
(952) 495-2000
(952) 495-2060
Mailing address
2200 COMMERCE BLVD, MOUND, MN 55364-1547
(952) 495-2000
(952) 495-2060
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19846
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19846
MEDICAL LICENSE
—
Enumeration date
07/20/2005
Last updated
07/08/2007
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