Individual
DAVID LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
705 E MARSHALL AVE STE 1002, LONGVIEW, TX 75601
(903) 759-7200
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
BP10057146
TX
207Q00000X
Family Medicine Physician
Primary
R7800
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400288301
—
TX
01
—
817012
MEDICARE
TX
01
—
8LE902
BCBS
TX
Enumeration date
06/08/2016
Last updated
01/29/2025
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