Individual
BEAU LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W BROADWAY ST STE 320, MISSOULA, MT 59802-4003
(406) 329-5615
Mailing address
PO BOX 31001, PASADENA, CA 91110-4110
(406) 329-5615
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-164422
MT
Other
Enumeration date
08/21/2025
Last updated
12/09/2025
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