Individual
DR. DANIEL J. LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 SCOTT AND WHITE DR, COLLEGE STATION, TX 77845-6440
(979) 207-4000
(979) 207-4562
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
L5425
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060070110
RR/MEDICARE
TX
05
—
1509697-02
—
TX
01
—
1509697-03
CSHCN
TX
01
—
8F1196
BLUE SHIELD
TX
Enumeration date
03/29/2006
Last updated
09/30/2020
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