Healthcare Provider Details

I. General information

NPI: 1962636845
Provider Name (Legal Business Name): DAVID LAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 03/07/2023
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17900 N PORTER RD
MARICOPA AZ
85138-4228
US

IV. Provider business mailing address

17900 N PORTER RD
MARICOPA AZ
85138-4228
US

V. Phone/Fax

Practice location:
  • Phone: 520-233-2500
  • Fax: 520-233-2688
Mailing address:
  • Phone: 520-233-2500
  • Fax: 520-233-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number253530-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP4073
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: