Individual
RYAN L LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2826 HARRIS ST, EUREKA, CA 95503-4809
(707) 443-8066
(707) 268-3250
Mailing address
2826 HARRIS ST, EUREKA, CA 95503-4809
(707) 443-8066
(707) 268-3250
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA17509
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0PA175090
—
CA
01
—
970003244
RAILROAD MEDICARE
—
Enumeration date
07/18/2006
Last updated
02/18/2015
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