Individual
DR. KENNETH W. LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 S NATIONAL AVE, SUITE 1950, SPRINGFIELD, MO 65804-2265
(417) 820-7250
(417) 820-7255
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
105284
MO
2086S0127X
Trauma Surgery Physician
105284
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207672502
—
MO
01
—
431560263
TRICARE
MO
Enumeration date
11/30/2006
Last updated
05/02/2013
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