Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. SHANE LYLE LARSON, M.D.
ActiveDR. SHANE LYLE LARSON, M.D. is a Sports Medicine healthcare provider located in FORT EUSTIS, Virginia. NPI 1750601191 is currently active in the NPPES registry. Verify at CMS.
Sports Medicine · FORT EUSTIS, VA
Registration Details
- NPI Number
- 1750601191
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 8, 2010 (16.139684829591 yrs)
- Last Updated
- Apr 27, 2022
- Licenses
-
67238 (GA)67238 (GA)
Practice Information
- Address
-
576 JEFFERSON AVEFORT EUSTIS, VA, 236041373Browse VA providers · Browse ZIP 23604
- Phone
- 7578201043
- Fax
- 7578201122
- Primary Specialty
-
Sports Medicine
207QS0010X
- Additional Specialty
- Sports Medicine
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.