Larson, Shane Lyle

Larson, Shane Lyle is an individual health care provider with primary practice located at 576 Jefferson Ave , Fort Eustis VA 23604-1373. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Larson, Shane Lyle can be contacted via phone (757) 820-1043.

Contact Information

Primary practice address
576 Jefferson Ave Fort Eustis VA 23604-1373
Phone: (757) 820-1043
Fax: (757) 820-1122
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 67238 Georgia
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 67238 Georgia

Profile Details

NPI number 1750601191
LBN Legal business name Larson, Shane Lyle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2010
Last updated Apr 27th, 2022 - about 2 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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