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NPI Code Detail

MEDICARE: MRS. JAMIE P LARSEN PAC

MEDICARE: MRS. JAMIE P LARSEN PAC
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
1207VG0400XGynecology Physician57597411206UT
2363AM0700XMedical Physician Assistant57597411206UT
3363AM0700XMedical Physician Assistant5177AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659410983
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAMIE P LARSEN PAC
Provider Business Mailing Address
First Line : 25 CROSSROADS DR STE 306
Second Line :
City : OWINGS MILLS
State : MD
Zip : 21117-5437
Country : US
Telephone Number : 602-222-1900
Fax Number :
Provider Business Practice Location Address
First Line : 2530 E SOUTHERN AVE
Second Line :
City : MESA
State : AZ
Zip : 85204-5411
Country : US
Telephone Number : 480-834-4188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 05/20/2024

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Directions to “ MRS. JAMIE P LARSEN PAC” Practice Location

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