Individual
LAURA JR LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2315 W 57TH ST, SIOUX FALLS, SD 57108-5046
(605) 336-3503
(605) 336-6010
Mailing address
2315 W 57TH ST, SIOUX FALLS, SD 57108-5046
(605) 336-3503
(605) 336-6010
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
1576
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1953018
—
IA
01
—
4996175
BLUE SHIELD
SD
05
—
6520152
—
SD
05
—
931873900
—
MN
Enumeration date
07/07/2005
Last updated
11/13/2009
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