Provider Demographics
NPI:1295990141
Name:LARSON, CHRISTOPHER M
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:LARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S PENN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4553
Mailing Address - Country:US
Mailing Address - Phone:605-229-1367
Mailing Address - Fax:605-229-1002
Practice Address - Street 1:310 S PENN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4553
Practice Address - Country:US
Practice Address - Phone:605-229-1367
Practice Address - Fax:605-229-1002
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7279208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7302260Medicaid
SD7302260Medicaid