Individual
GARY L LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5911 W MEMORIAL RD, OKLAHOMA CITY, OK 73142-2015
(405) 773-6530
Mailing address
PO BOX 248856, OKLAHOMA CITY, OK 73124-8856
(405) 607-4520
(405) 607-4525
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
13856
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088460A
—
OK
01
—
300042703
RAILROAD MEDICARE
—
Enumeration date
06/23/2006
Last updated
05/21/2024
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