Individual
LARRY VAN CARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 110, FORT WAYNE, IN 46845-1673
(260) 425-6780
(260) 425-6615
Mailing address
PO BOX 9788, BELFAST, ME 04915-9788
(910) 295-0215
(910) 295-0218
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
0101039834
VA
207T00000X
Neurological Surgery Physician
Primary
01082907A
IN
207T00000X
Neurological Surgery Physician
14284
WV
207T00000X
Neurological Surgery Physician
2008-02090
NC
207T00000X
Neurological Surgery Physician
20197
GA
207T00000X
Neurological Surgery Physician
25835
TN
208200000X
Plastic Surgery Physician
01082907A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0089635000
—
WV
05
—
5911722
—
NC
Enumeration date
09/22/2006
Last updated
12/09/2024
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