Provider Demographics
NPI:1104142678
Name:LARSON, BRETT DAVID (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:DAVID
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:712 S CASCADE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2913
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:218-739-6718
Practice Address - Street 1:1525 E 6000 S STE A
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-7149
Practice Address - Country:US
Practice Address - Phone:801-337-5800
Practice Address - Fax:801-337-5858
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN60490207V00000X
OH35125228207V00000X
UT12706124-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology