Provider Demographics
NPI:1487016432
Name:LARSON, ERIC STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:STANLEY
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 1:23456 HAWTHORNE BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4716
Mailing Address - Country:US
Mailing Address - Phone:310-375-8700
Mailing Address - Fax:310-375-8776
Practice Address - Street 1:23456 HAWTHORNE BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4716
Practice Address - Country:US
Practice Address - Phone:310-375-8700
Practice Address - Fax:310-375-8776
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172788207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery