Brent James Larson (NPI# 1659759082, PAC ID# 2062762479) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PODIATRY.
| Nation Provider ID (NPI) | 1659759082 |
| PAC ID by PECOS | 2062762479 |
| Professional Enrollment ID | I20180906000273 |
| Full Name | Brent James Larson |
| Organization Legal Name | ACTIVE FEET, FOOT AND ANKLE HEALTH CENTER |
| Address |
6625 Lyndale Ave S Suite 105 Richfield MN 55423-2673 |
| Phone Number | 6127888778 |
| Gender | M |
| Medical School | COLLEGE PODIATRIC MEDICINE AND SURGERY UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES |
| Graduation Year | 2014 |
| Primary Specialty | PODIATRY |
| Group Practice PAC ID | 1254401300 |
| Number of Group Practice Members | 10 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 2805 Campus Dr, Suite 225, Plymouth, MN 55441-2678 | 6127888778 | ACTIVE FEET, FOOT AND ANKLE HEALTH CENTER |
| 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 | 6127888778 | ACTIVE FEET, FOOT AND ANKLE HEALTH CENTER |
| 6625 Lyndale S Ave, Suite 105, Richfield, MN 55423 | 6127888778 | IN HOUSE SENIOR SERVICES, LLC |
| Organization Legal Name | ACTIVE FEET, FOOT AND ANKLE HEALTH CENTER |
| Physicians | 10 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Dale Herbert Vancil | Podiatry | Active Feet, Foot and Ankle Health Center | 4001 Stinson Blvd, Suite 120, Saint Anthony, MN 55421-3424 |
| John W Cheesebro | Podiatry | Active Feet, Foot and Ankle Health Center | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Eric Nelson | Podiatry | Active Feet, Foot and Ankle Health Center | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Eric W Affeldt | Podiatry | Active Feet, Foot and Ankle Health Center | 4001 Stinson Blvd, Suite 120, Saint Anthony, MN 55421-3424 |
| Scott C Knutson | Podiatry | Active Feet, Foot and Ankle Health Center | 4001 Stinson Blvd, Suite 120, Saint Anthony, MN 55421-3424 |
| Michael B Debrule | Podiatry | Active Feet, Foot and Ankle Health Center | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Allison Damon Willkom | Podiatry | Active Feet, Foot and Ankle Health Center | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Todd Aaron Peabody | Podiatry | Active Feet, Foot and Ankle Health Center | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Craig R Marsh | Podiatry | Active Feet, Foot and Ankle Health Center | 4001 Stinson Blvd, Suite 120, Saint Anthony, MN 55421-3424 |
| Street Address |
6625 LYNDALE AVE S SUITE 105 |
| City | RICHFIELD |
| State | MN |
| Zip | 55423-2673 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kirsten L Daniels | Qualified Audiologist | In House Senior Services, LLC | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Deborah E Fisher | Psychologist, Clinical | Stepping Stone Clinic LLC | 6625 Lyndale Ave S, Suite 500, Richfield, MN 55423-2691 |
| John W Cheesebro | Podiatry | Active Feet, Foot and Ankle Health Center | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Eric Nelson | Podiatry | Active Feet, Foot and Ankle Health Center | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Andrew K Scarbrough | Psychologist, Clinical | Stepping Stone Clinic LLC | 6625 Lyndale Ave S, Suite 500, Richfield, MN 55423-2691 |
| Rachelle E Hansen | Psychologist, Clinical | Stepping Stone Clinic LLC | 6625 Lyndale Ave S, Suite 500, Richfield, MN 55423-2691 |
| Amanda A Pojanowski | Optometry | In House Senior Services, LLC | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Michael B Debrule | Podiatry | Active Feet, Foot and Ankle Health Center | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Allison Damon Willkom | Podiatry | Active Feet, Foot and Ankle Health Center | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Todd Aaron Peabody | Podiatry | Active Feet, Foot and Ankle Health Center | 6625 Lyndale Ave S, Suite 105, Richfield, MN 55423-2673 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Bryan L Mohr | Podiatry | In House Senior Services, LLC | 6625 Lyndale S Ave, Suite 105, Richfield, MN 55423 |
| Karimah Z Shabazz | Podiatry | In House Senior Services, LLC | 6625 Lyndale S Ave, Suite 105, Richfield, MN 55423 |
| Deneen Zaetta | Optometry | In House Senior Services, LLC | 6625 Lyndale S Ave, Suite 105, Richfield, MN 55423 |
| Martha S Takata | Qualified Audiologist | In House Senior Services, LLC | 6625 Lyndale S Ave, Suite 105, Richfield, MN 55423 |
| Judith Demorest | Qualified Audiologist | In House Senior Services, LLC | 6625 Lyndale S Ave, Suite 105, Richfield, MN 55423 |
| Kirsten Marie Krein | Optometry | In House Senior Services, LLC | 6625 Lyndale S Ave, Suite 105, Richfield, MN 55423 |
| Michael Thomas Wallerich | Optometry | In House Senior Services, LLC | 6625 Lyndale S Ave, Suite 105, Richfield, MN 55423 |
| John H Voss | Qualified Audiologist | Audiology Concepts LLC | 6444 Xerxes Ave S, Edina, MN 55423-1039 |
| Jason R Leyendecker | Qualified Audiologist | Audiology Concepts LLC | 6444 Xerxes Ave S, Edina, MN 55423-1039 |
| Stacey D Dimond | Qualified Audiologist | Audiology Concepts LLC | 6444 Xerxes Ave S, Edina, MN 55423-1039 |
| Find all physicians in zip 55423 | |||
| City | RICHFIELD |
| Zip Code | 55423 |
| Specialty | PODIATRY |
| City + Specialty | RICHFIELD + PODIATRY |
Please comment or provide details below to improve the information on Brent James Larson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.