Most Relevant Information
Provider Data
| NPI Number: | 1003279456 |
| Provider Name: | CODY BRAXTON LARSEN MD |
| Entity Type: | Individual |
| Taxonomy Code: | 207P00000X |
| Specialty: | Emergency Medicine |
| License Number: | 25MA10897300 |
Most Important Dates
| Enumeration Date: | 04/02/2016 |
| Last Updated: | 04/20/2022 |
Provider Practice Location
800 WHEELING AVE
GLEN DALE
WV
260381660
Practice Location Phone/Fax
| Phone: | 3048453211 |
| Fax: |
Provider Mailing Location
263 18TH AVE
SAN FRANCISCO
CA
941212314
Provider Mailing Phone/Fax
| Phone: | 4157044757 |
| Fax: |