Individual
JOHN W LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
490 S MAPLE ST, SUITE 205, WACONIA, MN 55387-1760
(952) 925-5626
(952) 442-2180
Mailing address
490 S MAPLE ST, SUITE 205, WACONIA, MN 55387-1760
(952) 925-5626
(952) 442-2180
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
Primary
20221
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
489395600
—
MN
Enumeration date
08/29/2006
Last updated
05/12/2008
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