Larson, Rebecca J

Larson, Rebecca J is an individual health care provider with primary practice located at 751 N Rutledge St Suite 2300, Springfield IL 62702-4968. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is her primary health care specialty. Larson, Rebecca J can be contacted via phone (217) 545-8000.

Contact Information

Primary practice address
751 N Rutledge St Suite 2300 Springfield IL 62702-4968
Phone: (217) 545-8000
Fax: (217) 545-4485
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 036-132957 Illinois
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X 036-132957 Illinois

Profile Details

NPI number 1063674588
LBN Legal business name Larson, Rebecca J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 26th, 2008
Last updated Oct 22nd, 2020 - about 4 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 1063674588 NPPES
Illinois MEDICAID 036132957

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