Provider Demographics
NPI:1255302352
Name:LARSON, SETH EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:EDWARD
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 TATE BLVD SE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HICKERY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1498
Mailing Address - Country:US
Mailing Address - Phone:828-328-5500
Mailing Address - Fax:828-485-2517
Practice Address - Street 1:10474 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3015
Practice Address - Country:US
Practice Address - Phone:623-972-3800
Practice Address - Fax:623-972-1089
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006 017612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890241PMedicaid
AZH95876Medicare UPIN
NC890241PMedicaid
NC2320111Medicare PIN
NCH95876Medicare UPIN