Individual
DR. ROGER A LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1237 W DIVIDE AVE, STE 5, BISMARCK, ND 58501-1208
(701) 328-8883
(701) 328-8900
Mailing address
1237 W DIVIDE AVE, STE 5, BISMARCK, ND 58501-1208
(701) 328-8883
(701) 328-8900
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
219
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004479
BCBS OF ND PIN
—
Enumeration date
06/09/2006
Last updated
07/08/2007
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