Individual
PAUL LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1027 BELLEVUE AVE STE 200, SAINT LOUIS, MO 63117-1851
(314) 645-6450
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036.140112
IL
207RC0000X
Cardiovascular Disease Physician
Primary
2020022472
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020022472
LICENSE
MO
Enumeration date
04/13/2012
Last updated
10/23/2020
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