Individual
DR. ERIC MOWATT-LARSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
C55209
CA
207P00000X
Emergency Medicine Physician
0101230922
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
235963
BLUE SHIELD
VA
05
—
5861047
—
VA
05
—
5910835
—
NC
01
—
930107776
RAILROAD MEDICARE
VA
Enumeration date
06/18/2006
Last updated
02/24/2021
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