Individual
JEREMY TODD LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1818 E REZANOF DR, KODIAK, AK 99615
(907) 486-6065
(907) 486-2248
Mailing address
1818 E REZANOF DR, KODIAK, AK 99615
(907) 486-6065
(907) 486-2248
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
44523
WA
207Q00000X
Family Medicine Physician
Primary
4934
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8419657
—
WA
Enumeration date
09/15/2006
Last updated
10/04/2009
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