Individual
DR. JONATHAN DAVID LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8401 DATAPOINT DR, SUITE 500, SAN ANTONIO, TX 78229-5900
(210) 614-0180
(210) 615-7170
Mailing address
8401 DATAPOINT DR, SUITE 500, SAN ANTONIO, TX 78229-5900
(210) 614-0180
(210) 615-7170
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
A101354
CA
207P00000X
Emergency Medicine Physician
Primary
N2618
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203048801
—
TX
01
—
8CA609
BCBSTX
TX
Enumeration date
09/21/2007
Last updated
07/25/2024
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