Provider Demographics
NPI:1467617050
Name:LARSON, SCOTT A (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 LANTERN BEND DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2840
Mailing Address - Country:US
Mailing Address - Phone:281-440-0101
Mailing Address - Fax:855-404-4345
Practice Address - Street 1:275 LANTERN BEND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2840
Practice Address - Country:US
Practice Address - Phone:281-440-0101
Practice Address - Fax:855-404-4345
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3187207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00937257OtherRAILROAD MEDICARE
MNENROLLEDMedicaid
IAENROLLEDMedicaid
IAENROLLEDMedicaid
TX349035YKS3Medicare PIN