Provider Demographics
NPI:1144340712
Name:LARSEN, TERRY LEE (DO)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:LARSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-0905
Mailing Address - Country:US
Mailing Address - Phone:802-748-8141
Mailing Address - Fax:
Practice Address - Street 1:205 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2312
Practice Address - Country:US
Practice Address - Phone:605-698-4665
Practice Address - Fax:605-698-6401
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032.0066383208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075442Medicaid
VT1017931Medicaid
VT0018752Medicare PIN