MEDICARE: JAMES CHRISTEN LARSEN III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	0101270310	VA
2	2085R0202X	Diagnostic Radiology Physician	51860	AZ

General Provider Information

NPI Number	:	1366767352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES CHRISTEN LARSEN III M.D.

Provider Business Mailing Address
First Line	:	2616 W KILTIE LN
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86005-9109
Country	:	US
Telephone Number	:	775-560-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 W FOREST AVE STE 101
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-1482
Country	:	US
Telephone Number	:	928-773-2515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	03/10/2026

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