Provider Demographics
NPI:1801038070
Name:LARSON, SCOTT VON (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:VON
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4571 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1156
Mailing Address - Country:US
Mailing Address - Phone:239-333-0772
Mailing Address - Fax:239-244-2049
Practice Address - Street 1:4571 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1156
Practice Address - Country:US
Practice Address - Phone:239-333-0772
Practice Address - Fax:239-244-2049
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL145087207Y00000X
CT052686207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology