Provider Demographics
NPI:1134124019
Name:LARSON, ERIC A (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:STE 510
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0410
Practice Address - Country:US
Practice Address - Phone:605-328-7500
Practice Address - Fax:605-328-7599
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD4727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6003755Medicaid
SDS8320Medicare PIN
G93531Medicare UPIN
SDS40365Medicare PIN