Provider Demographics
NPI:1174595714
Name:LARGEN, THOMAS HOMER (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HOMER
Last Name:LARGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:IA
Mailing Address - Zip Code:51640-1300
Mailing Address - Country:US
Mailing Address - Phone:712-382-2626
Mailing Address - Fax:712-382-1931
Practice Address - Street 1:1219 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:IA
Practice Address - Zip Code:51640-1300
Practice Address - Country:US
Practice Address - Phone:712-382-2626
Practice Address - Fax:712-382-1931
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0018499Medicaid
IA01849OtherWELLMARK BC/BS OF IA
A00231Medicare UPIN
IA01849Medicare ID - Type Unspecified