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General NPI Number Information
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NPI Number | 1477513562
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Entity Type | Individual
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Provider Name | DON K LARUE MPAS,APA-C
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 HWY 89 NORTH
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City | PRESCOTT
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State | AZ
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Zip | 86313
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Country | US
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Telephone | 800-949-1005
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Fax | 928-776-6125
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Provider Business Mailing Address
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Address Line | 5231 N LONE DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-4339
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Country | US
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Telephone | 800-949-1005
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Fax | 928-776-6125
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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 | 186
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License Number State | WY
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