Individual
PAUL LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 PONTIAC AVE STE 101, CRANSTON, RI 02920-4486
(401) 944-4330
(401) 464-4071
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
(401) 444-6779
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD17835
RI
207Q00000X
Family Medicine Physician
MD425506
PA
Other
Enumeration date
01/05/2009
Last updated
07/27/2021
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