Individual
DR. MICHAEL J LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
360 EAST MAIN, REXBURG, ID 83440
(208) 356-9550
(208) 356-8023
Mailing address
360 EAST MAIN, REXBURG, ID 83440
(208) 356-9550
(208) 356-8023
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
M-5158
ID
207X00000X
Orthopaedic Surgery Physician
Primary
M5158
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003807100
—
ID
Enumeration date
05/27/2005
Last updated
12/14/2009
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