Provider Demographics
NPI:1164719779
Name:PARSONS, LARRY W
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:W
Last Name:PARSONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5874
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:802 AINSWORTH DR STE B&C
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1623
Practice Address - Country:US
Practice Address - Phone:928-775-5567
Practice Address - Fax:928-772-1522
Is Sole Proprietor?:No
Enumeration Date:2011-07-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19358207QH0002X
AZ50163207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ013361Medicaid
AZ50163OtherMEDICAL LICENSE
AZ50163OtherMEDICAL LICENSE