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Individual

BRIAN J LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3485 INDEPENDENCE DR, HOMEWOOD, AL 35209-5603
(205) 414-4402
(205) 414-4425
Mailing address
3485 INDEPENDENCE DR, HOMEWOOD, AL 35209-5603
(205) 414-4402
(205) 414-4425

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
11787
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0366100001
MC NSC
AL
01
P00462711
RAILROAD MEDICARE PTAN
AL
Enumeration date
06/21/2005
Last updated
09/28/2009
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