Provider Demographics
NPI:1730116674
Name:LARSON, DAVID WILBUR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILBUR
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 1:496 ALTAPASS HWY
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777
Mailing Address - Country:US
Mailing Address - Phone:828-765-0170
Mailing Address - Fax:828-765-5877
Practice Address - Street 1:496 ALTAPASS HWY
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777
Practice Address - Country:US
Practice Address - Phone:828-765-0170
Practice Address - Fax:828-765-5877
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00513OtherBLUE CROSS
NC201464GOtherMEDICARE PHYSICIAN
NC34U011OtherMEDICARE SWINGBED
NC07673OtherBLUE CROSS PHYSICIAN
NC014MXOtherBLUE CROSS LABS
NC51049OtherBCBS INDIVIDUAL PROVIDER
NC0081POtherBCBS SWINGBED
NC8951049OtherMEDICAID
C85124Medicare UPIN
NC340011Medicare Oscar/Certification