Provider Demographics
NPI:1578541801
Name:LARSON, DAVID MEIUM (PNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MEIUM
Last Name:LARSON
Suffix:
Gender:M
Credentials:PNP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27585
Mailing Address - Street 2:VALLEY HI POST OFFICE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-0585
Mailing Address - Country:US
Mailing Address - Phone:210-292-6248
Mailing Address - Fax:210-292-7902
Practice Address - Street 1:2200 BERGQUIST DR
Practice Address - Street 2:WILFORD HALL MEDICAL CENTER, 8C/MMNP
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9907
Practice Address - Country:US
Practice Address - Phone:210-292-6248
Practice Address - Fax:210-292-7902
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX708931363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics