Provider Demographics
NPI:1346217882
Name:SARGENT, LARRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:A
Last Name:SARGENT
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 1:620 MEDICAL DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5084
Mailing Address - Country:US
Mailing Address - Phone:801-295-6554
Mailing Address - Fax:801-294-4983
Practice Address - Street 1:620 MEDICAL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5084
Practice Address - Country:US
Practice Address - Phone:801-295-6554
Practice Address - Fax:801-294-4983
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN181702086S0122X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000348466AMedicaid
TN2006636OtherBCBS GROUP
TNPLF03906636OtherCHAMPUS
TN0151430OtherBCBS
TN240004378OtherRAILROAD MEDICARE
TN1348074OtherUNITED HEALTHCARE INS.
TNTN0105OtherJOHN DEERE INS.
TN1114640001OtherPALMETTO DME
TN1348074OtherUNITED HEALTHCARE INS.
C49446Medicare UPIN