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General NPI Number Information
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NPI Number | 1548647472
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Entity Type | Individual
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Provider Name | SEAN LARSEN
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Gender | Male
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 12033 AGENCY RD
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City | PARKER
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State | AZ
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Zip | 85344-7718
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Country | US
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Telephone | 928-669-2137
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Fax | 928-669-3131
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Provider Business Mailing Address
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Address Line | 1200 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-213-6235
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Fax | 928-213-6292
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 6014
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 008197
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License Number State | AZ
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