Provider Demographics
NPI:1144434242
Name:LARSON, TIMOTHY BRAD (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRAD
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 1:2435 W OAK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4313
Mailing Address - Country:US
Mailing Address - Phone:940-299-4263
Mailing Address - Fax:940-535-7326
Practice Address - Street 1:2435 W OAK ST STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4313
Practice Address - Country:US
Practice Address - Phone:940-299-4263
Practice Address - Fax:940-535-7326
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6670207X00000X, 207XS0106X, 207XS0106X
NC141050207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323428801Medicaid
TX323428802Medicaid
TX307457YKPWMedicare PIN
TX323428802Medicaid