Provider Demographics
NPI:1649391772
Name:ERIC W. LARSON, M.D., PLLC
Entity Type:Organization
Organization Name:ERIC W. LARSON, M.D., PLLC
Other - Org Name:ERIC W. LARSON, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEV
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-920-6825
Mailing Address - Street 1:6525 DREW AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2103
Mailing Address - Country:US
Mailing Address - Phone:952-920-6748
Mailing Address - Fax:952-920-3863
Practice Address - Street 1:6525 DREW AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2103
Practice Address - Country:US
Practice Address - Phone:952-920-6748
Practice Address - Fax:952-920-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN285332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN131L0LAOtherBCBS MN
MN172494OtherUCARE MN
MND81794Medicare UPIN