Individual
PETER JON LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1285 NININGER RD, HASTINGS, MN 55033-1086
(651) 480-4200
(651) 480-4434
Mailing address
8675 VALLEY CREEK RD, WOODBURY, MN 55125-2337
(651) 241-3000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9355
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-13610
MEDICA
MN
05
—
040965100
—
MN
01
—
127666
UCARE MINNESOTA
MN
01
—
16F30LA
BLUE CROSS
MN
01
—
42990800
GROUP HEALTH EAU CLAIRE
MN
01
—
850267
AMERICA'S PPO
MN
01
—
970015689
RAILROAD MEDICARE
MN
01
—
HP30168
HEALTH PARTNERS
MN
01
—
NA9141022759
PREFERRED ONE
MN
Enumeration date
04/08/2006
Last updated
03/23/2021
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