Individual
RICHARD LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1153 CENTRE ST, JAMAICA PLAIN, MA 02130-3446
(617) 983-7132
Mailing address
7 PERRY RD, NATICK, MA 01760-1625
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
50306
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6180396
—
MA
01
—
E18015
BLUE SHIELD
MA
Enumeration date
01/22/2007
Last updated
07/08/2007
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