Provider Demographics
NPI:1346703634
Name:LARSON, MATTHEW DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DANIEL
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7107 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1607
Mailing Address - Country:US
Mailing Address - Phone:605-321-6428
Mailing Address - Fax:
Practice Address - Street 1:201 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2403
Practice Address - Country:US
Practice Address - Phone:605-336-0635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN77624208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology