Provider Demographics
NPI:1861440653
Name:LARSON, STEVEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:S
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 E SCHUSTER AVE
Mailing Address - Street 2:BUILDING 4B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4672
Mailing Address - Country:US
Mailing Address - Phone:915-351-9200
Mailing Address - Fax:915-351-9266
Practice Address - Street 1:5959 GATEWAY BLVD W
Practice Address - Street 2:SUITE 120
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3331
Practice Address - Country:US
Practice Address - Phone:915-779-1716
Practice Address - Fax:915-779-1754
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5281208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120292105Medicaid
C18175Medicare UPIN
TX00A45PMedicare PIN