Provider Demographics
NPI:1609893247
Name:LARSON, LISA C (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:500 OFFICE PARK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2437
Mailing Address - Country:US
Mailing Address - Phone:205-803-4330
Mailing Address - Fax:205-803-4354
Practice Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 628
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6808
Practice Address - Country:US
Practice Address - Phone:205-870-4783
Practice Address - Fax:205-879-7043
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-11-01
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Provider Licenses
StateLicense IDTaxonomies
AL14626207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD87360Medicare UPIN