MEDICARE: LAURIE DENISE LARSEN MD

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	208800000X	Urology Physician	7216	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780685859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE DENISE LARSEN MD

Provider Business Mailing Address
First Line	:	3131 LA CANADA ST
Second Line	:	STE 217
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2578
Country	:	US
Telephone Number	:	702-796-8669
Fax Number	:	702-796-9517

Provider Business Practice Location Address
First Line	:	3121 S MARYLAND PKWY
Second Line	:	STE 420
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2307
Country	:	US
Telephone Number	:	702-796-8669
Fax Number	:	702-796-9517

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/25/2013

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Directions to “ LAURIE DENISE LARSEN MD” Practice Location

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