Provider Demographics
NPI:1326130204
Name:LARSON, TIMOTHY GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GEORGE
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E 26TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4526
Mailing Address - Country:US
Mailing Address - Phone:612-884-6300
Mailing Address - Fax:612-884-6363
Practice Address - Street 1:910 E 26TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4526
Practice Address - Country:US
Practice Address - Phone:612-884-6300
Practice Address - Fax:612-884-6363
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38013207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3601103OtherMEDICA
MN3601103OtherSELECT CARE
MN1009049OtherPREFERRED ONE
MN7K142LAOtherBLUE CROSS BLUE SHIELD
MN892718900Medicaid
MN892718900Medicaid
MNF39555Medicare UPIN