Provider Demographics
NPI:1346022415
Name:LARN, SAMUEL ELLIS
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ELLIS
Last Name:LARN
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 1:3429 W 31ST AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3647
Mailing Address - Country:US
Mailing Address - Phone:323-428-7974
Mailing Address - Fax:
Practice Address - Street 1:3429 W 31ST AVE APT 3
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3647
Practice Address - Country:US
Practice Address - Phone:323-428-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health