Provider Demographics
NPI:1356324511
Name:LARSON, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:LARSON
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 1:345 E GATEWAY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-4625
Mailing Address - Country:US
Mailing Address - Phone:435-657-0101
Mailing Address - Fax:435-315-3146
Practice Address - Street 1:345 E GATEWAY DR STE 150
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-4625
Practice Address - Country:US
Practice Address - Phone:435-657-0101
Practice Address - Fax:435-315-3146
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363586-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics