Individual
ERIC WINDSOR LARSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SUBMARINE IDC
Contact information
Practice address
580 USS MARIANO G VALLEJO AVE, NSSC MEDICAL KINGS BAY, KINGS BAY, GA 31547
(912) 573-2939
Mailing address
117 BETTINGER PL, SAINT MARYS, GA 31558-4665
(912) 576-1541
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/30/2006
Last updated
09/19/2008
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