Provider Demographics
NPI:1316958051
Name:LARSON, TODD DUANE (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:DUANE
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9285 HEPBURN ST
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2262
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035391207R00000X, 207RS0010X
CO49540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO021482OtherKAISER COMMERCIAL NUMBER
WA8211799Medicaid
WA0126517OtherSTATE L&I
WA110184901OtherMEDICARE RAILROAD
WA8930011OtherSTATE CRIME VICTIMS
CO78486572Medicaid
COCOAAA0287Medicare PIN
CO021482OtherKAISER COMMERCIAL NUMBER
WA110184901OtherMEDICARE RAILROAD