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Individual

JUSTIN LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 689-8333
Mailing address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 689-8333

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01083756A
IN
207P00000X
Emergency Medicine Physician
Primary
036150740
IL

Other

Enumeration date
03/30/2017
Last updated
08/11/2020
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