Larson, John Robert

Larson, John Robert is an sole proprietor health care provider with primary practice located at 1724 W Plymouth St , Bremen IN 46506-1940. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Obstetrics. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Larson, John Robert can be contacted via phone (574) 546-3649.

Contact Information

Primary practice address
1724 W Plymouth St Bremen IN 46506-1940
Phone: (574) 546-3649
Fax: (574) 546-3952
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01033673 Indiana
Allopathic & Osteopathic Physicians / Obstetrics 207VX0000X 01033673 Indiana

Profile Details

NPI number 1215932173
LBN Legal business name Larson, John Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 16th, 2005
Last updated Jan 14th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215932173 NPPES
Indiana MEDICAID 100468970B
Indiana Other 371199381
Indiana Other 000000296642
Indiana Other 0004619574

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