Individual
WAYNE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3501 JOHNSON ST FL 2, HOLLYWOOD, FL 33021-5421
(954) 265-3441
(954) 985-2294
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
(954) 276-5685
(954) 985-7074
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01081854A
IN
207V00000X
Obstetrics & Gynecology Physician
Primary
ME148416
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110682900
—
FL
Enumeration date
04/30/2015
Last updated
07/22/2021
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