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General NPI Number Information
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NPI Number | 1124273032
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Entity Type | Organization
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Legal Business Name | CENTER FOR COLON AND RECTAL DISEASES PLC
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 1500 S DOBSON RD SUITE 313
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City | MESA
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State | AZ
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Zip | 85202-4713
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Country | US
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Telephone | 480-964-0707
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Fax | 480-464-0588
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Provider Business Mailing Address
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Address Line | 1500 S DOBSON ROAD SUITE 313
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City | MESA
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State | AZ
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Zip | 85202-4713
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Country | US
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Telephone | 480-964-0707
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Fax | 480-464-0588
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID MICHAEL LARSON
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Credential | M.D.
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Telephone | 480-964-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 12943
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License Number State | AZ
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