Provider Demographics
NPI:1609164391
Name:LARSON, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVE
Other - Middle Name:MICHAEL
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:345 SAXONY RD STE 206
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2792
Mailing Address - Country:US
Mailing Address - Phone:760-230-1317
Mailing Address - Fax:760-456-4703
Practice Address - Street 1:345 SAXONY RD STE 206
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2792
Practice Address - Country:US
Practice Address - Phone:858-367-3401
Practice Address - Fax:760-456-4703
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1226662084P0800X, 207QA0505X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program