Individual
JEROME WILLIAM LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5801 E 41ST ST STE 900, TULSA, OK 74135-5631
(918) 747-4975
(918) 743-8552
Mailing address
PO BOX 4930, TULSA, OK 74159-0930
(918) 747-4975
(918) 743-8552
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
35610
OK
2085R0204X
Vascular & Interventional Radiology Physician
Primary
35610
OK
208600000X
Surgery Physician
125062965
IL
208D00000X
General Practice Physician
A162079
CA
Other
Enumeration date
05/21/2013
Last updated
11/21/2023
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