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NPI Code Detail

MEDICARE: DR. DAVID C. LARSON MD

MEDICARE: DR. DAVID C. LARSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician363586-1205UT

General Provider Information

NPI Number : 1356324511
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID C. LARSON MD
Provider Business Mailing Address
First Line : 345 E GATEWAY DR STE 150
Second Line :
City : HEBER CITY
State : UT
Zip : 84032-4625
Country : US
Telephone Number : 435-657-0101
Fax Number : 435-315-3146
Provider Business Practice Location Address
First Line : 345 E GATEWAY DR STE 150
Second Line :
City : HEBER CITY
State : UT
Zip : 84032-4625
Country : US
Telephone Number : 435-657-0101
Fax Number : 435-315-3146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 05/28/2021

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Directions to “ DR. DAVID C. LARSON MD” Practice Location

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