Provider Demographics
NPI:1265425466
Name:LARGEN, JOHN W JR (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:LARGEN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:1020 HOLCOMBE BLVD
Mailing Address - Street 2:STE 1304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2210
Mailing Address - Country:US
Mailing Address - Phone:713-799-2818
Mailing Address - Fax:713-790-1454
Practice Address - Street 1:1020 HOLCOMBE BLVD
Practice Address - Street 2:STE 1304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2210
Practice Address - Country:US
Practice Address - Phone:713-799-2818
Practice Address - Fax:713-790-1454
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX22321103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86691AOtherBCBS
5194361OtherAETNA PPO PRODUCTS
TX86691AOtherBCBS