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General NPI Number Information
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NPI Number | 1245222181
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Entity Type | Individual
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Provider Name | PHILIP J LARSEN DPM
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 10561 JEFFREYS ST 110
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City | HENDERSON
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State | NV
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Zip | 89052-4179
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Country | US
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Telephone | 702-456-3668
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Fax | 702-456-6688
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Provider Business Mailing Address
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Address Line | 10561 JEFFREYS ST #110
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City | HENDERSON
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State | NV
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Zip | 89052-4266
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Country | US
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Telephone | 702-456-3668
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Fax | 702-456-6688
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0005
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License Number State | NV
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