Individual
GREGORY PAUL LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 MEDICAL CENTER BLVD, SUITE 313, MARRERO, LA 70072-3151
(504) 842-4083
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD.206990
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06072737
—
MS
05
—
2375474
—
LA
Enumeration date
06/12/2009
Last updated
11/21/2014
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