DR. THEODORE CARL LARSON III (NPI# 1578663969) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578663969 |
| Entity Type | Individual |
| Full Name | DR. THEODORE CARL LARSON III |
| Credential | M.D. |
| Practice Address |
11750 W 2nd Pl Suite 255 Lakewood CO 80228 |
| Mailing Address |
11750 W 2nd Pl Ste 255 Lakewood CO 80228-1726 |
| Practice Telephone | 7203218040 |
| Practice Fax Number | 7203218041 |
| Mailing Telephone | 7203218040 |
| Mailing Fax Number | 7203218041 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2018-07-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085N0700X |
Radiology Specialization: Neuroradiology |
44928 | CO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 4853580 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9399 Crown Crest Blvd Ste 240, Parker, CO 801388571 | 3036493560 | 3036493561 |
| Street Address |
11750 W 2ND PL SUITE 255 |
| City | LAKEWOOD |
| State | CO |
| Zip Code | 80228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386647543 | Colorado Professional Medical, Inc | Prosthetic/Orthotic Supplier | 11750 W 2nd Pl, St. Anthony Medical Plaza, Lakewood, CO 80228-1575 | 2005-05-23 |
| 1457718108 | Philip R. Yarnell, M.d., P.C. | Specialist | 11750 W 2nd Pl, Medical Plaza I Suite 255, Lakewood, CO 80228-1575 | 2016-01-26 |
| 1912363755 | Michael Kent Mcdermid | Nurse Practitioner | 11750 W 2nd Pl, Medical Plaza 1 Suite 255, Lakewood, CO 80228-1575 | 2016-01-09 |
| 1164828026 | Catholic Health Initiatives Colorado | Internal Medicine | 11750 W 2nd Pl, Suite 365, Lakewood, CO 80228-1575 | 2014-11-05 |
| 1760806038 | Catholic Health Initiatives Colorado | Neurological Surgery | 11750 W 2nd Pl, Medical Plaza 1, Ste. 255, Lakewood, CO 80228-1575 | 2014-02-07 |
| 1578852042 | Laura Jeanne Friedlander | Psychiatry & Neurology | 11750 W 2nd Pl, Ste 255, Lakewood, CO 80228-1575 | 2011-04-05 |
| 1235462813 | Leon Stor | Physician Assistant | 11750 W 2nd Pl, Suite 255, Lakewood, CO 80228-1575 | 2009-09-14 |
| 1376772624 | Allison Beauneir | Internal Medicine | 11750 W 2nd Pl, Suite 365, Lakewood, CO 80228-1575 | 2009-07-08 |
| 1588891782 | Star Viviette Fowler | Internal Medicine | 11750 W 2nd Pl, Suite 365, Lakewood, CO 80228-1575 | 2009-06-15 |
| 1982869251 | Wesley D. Reynolds | Psychiatry & Neurology | 11750 W 2nd Pl, Ste 255, Lakewood, CO 80228-1575 | 2008-07-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174083570 | Lindsey Mae Beverly | Physician Assistant | Medical Plaza 2, 11700 W 2nd Pl, #350, Lakewood, CO 80228 | 2019-03-21 |
| 1881119931 | Cory J Frazier | Nurse Practitioner | 11600 W. 2nd Pl, Lakewood, CO 80228 | 2017-08-10 |
| 1508213885 | Chelsea Tucker | Counselor | 12157 W Cedar Dr Ste 207, Lakewood, CO 80228 | 2016-05-17 |
| 1972963841 | Shastin Gerbracht | Counselor | 12055 W 2nd Pl, Ste 200, Lakewood, CO 80228 | 2016-03-04 |
| 1073983375 | Suzanne Phillips | Behavioral Analyst | 200 Union Blvd. Ste. 200, Lakewood, Co. 80228, Denver, CO 80228 | 2015-09-29 |
| 1700265667 | April Mearsha | Doula | 12977 W Cedar Dr, 2-305, Lakewood, CO 80228 | 2015-05-26 |
| 1306233713 | Caleb Hedberg | Internal Medicine | 165 S Union Blvd Ste 800, Lakewood, CO 80228 | 2015-04-23 |
| 1972996288 | David Lindsey Currie | Counselor | 12055 W 2nd Place, Jefferson Ctr for Mental Health, Lakewood, CO 80228 | 2015-03-11 |
| 1619365533 | Michelle Broberg II | Technician | 12055 West 2nd Plaza, Lakewood, CO 80228 | 2014-12-30 |
| 1750789012 | Kayla Morrison | Social Worker | 12005 W 2nd Place, Lakewood, CO 80228 | 2014-12-18 |
| Find all providers in zip 80228 | ||||
| Taxonomy Code | 2085N0700X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Neuroradiology |
| A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689988644 | Michael Alexander Letzing | Radiology | 1746 Cole Blvd Ste 150, Lakewood, CO 80401 | 2010-08-02 |
| 1730373127 | Perry M Stevens | Radiology | 1746 Cole Blvd, Suite 150, Lakewood, CO 80401-3208 | 2007-08-29 |
| 1518167725 | David A Costantino | Radiology | 1746 Cole Blvd Ste 150, Lakewood, CO 80401-3267 | 2007-07-25 |
| 1932305513 | Forrester Dubus Lensing | Radiology | 11600 W 2nd Pl, Lakewood, CO 80228-1527 | 2007-06-21 |
| 1548316136 | Mark Alan Brinckman | Radiology | 1746 Cole Blvd, Suite 150, Lakewood, CO 80401-3208 | 2007-01-26 |
| 1568514289 | Hari Charan Pabbathi Reddy | Radiology | 1746 Cole Blvd, Suite 150, Lakewood, CO 80401-3208 | 2007-01-16 |
| 1336239946 | Perry Pak-nin Ng | Radiology | 11750 W 2nd Pl, Suite 255, Lakewood, CO 80228-1575 | 2006-10-13 |
| 1437263803 | Brian Mckay Steele | Radiology | 1746 Cole Blvd, Suite 150, Lakewood, CO 80401-3208 | 2006-08-19 |
| 1700897477 | Sean O. Bryant | Radiology | 1746 Cole Blvd, Ste 150, Lakewood, CO 80401-3208 | 2006-08-10 |
| 1841253986 | David Armin Weiland | Radiology | 11600 W 2nd Pl, Lakewood, CO 80228-1527 | 2006-04-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.