Provider Demographics
NPI:1275697534
Name:LARSON, DON A (PA-C)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:A
Last Name:LARSON
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:BOX 78534
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53278-8534
Mailing Address - Country:US
Mailing Address - Phone:815-398-9491
Mailing Address - Fax:815-381-7498
Practice Address - Street 1:650 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5944
Practice Address - Country:US
Practice Address - Phone:815-398-9491
Practice Address - Fax:815-381-7498
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2020-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL1072529363A00000X
IL085-002924363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant