Individual
TIMOTHY L LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1401 NWAKAMA ST, MARSHALL, MN 56258-5529
(507) 929-7696
(507) 393-7697
Mailing address
1401 NWAKAMA ST, MARSHALL, MN 56258-5529
(507) 929-7696
(507) 393-7697
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0386
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6826122
—
SD
Enumeration date
06/23/2006
Last updated
10/31/2011
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