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General NPI Number Information
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NPI Number | 1063430890
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Entity Type | Individual
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Provider Name | BRAD RODNEY LARSEN P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 1701 E PFLUGERVILLE PKWY
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-8990
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Country | US
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Telephone | 512-259-6000
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Fax | 512-260-6005
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Provider Business Mailing Address
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Address Line | PO BOX 844658
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City | DALLAS
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State | TX
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Zip | 75284-4658
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Country | US
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Telephone | 254-724-2111
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Fax | 801-715-8228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5166627-1206
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA02752
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License Number State | TX
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