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NPI Code Detail

MEDICARE: DR. DAVID C LARSEN MD

MEDICARE: DR. DAVID C LARSEN 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
1207Q00000XFamily Medicine Physician30852741205UT

Other Identifiers

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

General Provider Information

NPI Number : 1679548564
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID C LARSEN MD
Provider Business Mailing Address
First Line : 999 MURRAY HOLLADAY RD
Second Line : SUITE 207
City : SALT LAKE CITY
State : UT
Zip : 84117-4901
Country : US
Telephone Number : 801-268-2584
Fax Number : 801-262-1168
Provider Business Practice Location Address
First Line : 999 MURRAY HOLLADAY RD
Second Line : SUITE 207
City : SALT LAKE CITY
State : UT
Zip : 84117-4901
Country : US
Telephone Number : 801-268-2584
Fax Number : 801-262-1168
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 05/10/2011

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