Provider Demographics
NPI:1275820888
Name:LARSEN, JAIVA BLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIVA
Middle Name:BLAIR
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2800 E AJO WAY
Mailing Address - Street 2:UA/UPHK GME CONSORTIUM EMERGENCY MEDICINE PROGRAM
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-6204
Mailing Address - Country:US
Mailing Address - Phone:503-939-6612
Mailing Address - Fax:
Practice Address - Street 1:2800 E AJO WAY
Practice Address - Street 2:UA/UPHK GME CONSORTIUM EMERGENCY MEDICINE PROGRAM
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6204
Practice Address - Country:US
Practice Address - Phone:503-939-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-03
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZR72785207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine