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General NPI Number Information
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NPI Number | 1770599623
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Entity Type | Individual
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Provider Name | DANIEL KURTIS LARSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 7757 N. DEERFIELD
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City | PRESSCOTT
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State | AZ
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Zip | 86305-7747
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Country | US
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Telephone | 928-728-5626
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Fax | 509-835-4058
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Provider Business Mailing Address
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Address Line | 7757 N. DEERFIELD
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City | PRESCOTT
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State | AZ
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Zip | 86305-7747
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Country | US
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Telephone | 928-728-5626
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Fax | 509-835-4058
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 23114
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License Number State | WA
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