Healthcare Provider Details

I. General information

NPI: 1164719779
Provider Name (Legal Business Name): LARRY W PARSONS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2011
Last Update Date: 03/07/2023
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 AINSWORTH DR STE B&C
PRESCOTT AZ
86301-1623
US

IV. Provider business mailing address

PO BOX 10880
PRESCOTT AZ
86304-0880
US

V. Phone/Fax

Practice location:
  • Phone: 928-775-5567
  • Fax: 928-772-1522
Mailing address:
  • Phone: 928-759-5874
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number19358
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number50163
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: