Individual
KEITH D LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1511 NORTHWAY DR, SUITE 202, SAINT CLOUD, MN 56303-1261
(320) 217-8880
(320) 253-1822
Mailing address
1511 NORTHWAY DR, SUITE 202, SAINT CLOUD, MN 56303-1261
(320) 217-8880
(320) 253-1822
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
22693
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
313593400
—
MN
Enumeration date
03/21/2006
Last updated
09/01/2009
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