Provider Demographics
NPI:1689914434
Name:CYNTHIA E. LARSON, D.O., P.A.
Entity Type:Organization
Organization Name:CYNTHIA E. LARSON, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:409-833-5790
Mailing Address - Street 1:3070 COLLEGE ST
Mailing Address - Street 2:207
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4691
Mailing Address - Country:US
Mailing Address - Phone:409-833-5790
Mailing Address - Fax:409-833-5899
Practice Address - Street 1:3070 COLLEGE ST
Practice Address - Street 2:207
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4691
Practice Address - Country:US
Practice Address - Phone:409-833-5790
Practice Address - Fax:409-833-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXYU1SMedicare PIN