Provider Demographics
NPI:1306824149
Name:LARSEN, RALPH DAVID (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:DAVID
Last Name:LARSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7150 W SUNSET RD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1981
Mailing Address - Country:US
Mailing Address - Phone:702-385-4342
Mailing Address - Fax:702-385-4346
Practice Address - Street 1:9053 S PECOS RD
Practice Address - Street 2:SUITE 2900
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7177
Practice Address - Country:US
Practice Address - Phone:702-735-8000
Practice Address - Fax:702-735-4795
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT1668241205208800000X
NV6317208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019159Medicaid
NVV33978OtherMEDICARE ID
E31836Medicare UPIN
NVDE800ZMedicare PIN
NV002019159Medicaid