Provider Demographics
NPI:1578610739
Name:LARSEN, JOHN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:LARSEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1700 LOMBARD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-8211
Mailing Address - Country:US
Mailing Address - Phone:805-988-6510
Mailing Address - Fax:805-988-6550
Practice Address - Street 1:1700 LOMBARD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8211
Practice Address - Country:US
Practice Address - Phone:805-988-6510
Practice Address - Fax:805-988-6550
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG61959204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine