Larson, Wade M.
Larson, Wade M. is an individual health care provider with primary practice located at 13980 Northdale Blvd , Rogers MN 55374-2147. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Larson, Wade M. can be contacted via phone (763) 428-1920.Contact Information
Primary practice address
13980 Northdale Blvd
Rogers MN 55374-2147
Phone: (763) 428-1920
Fax: (763) 428-3162
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 40046 | Minnesota |
Profile Details
| NPI number | 1649247859 |
|---|---|
| LBN Legal business name | Larson, Wade M. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 7th, 2006 |
| Last updated | Sep 22nd, 2011 - about 13 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649247859 | NPPES |
| Minnesota | MEDICAID | 255439900 |
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