Provider Demographics
NPI:1477513562
Name:LARUE, DON K (MPAS,APA-C)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:K
Last Name:LARUE
Suffix:
Gender:M
Credentials:MPAS,APA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5231 N LONE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-4339
Mailing Address - Country:US
Mailing Address - Phone:800-949-1005
Mailing Address - Fax:928-776-6125
Practice Address - Street 1:500 HWY 89 NORTH
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:800-949-1005
Practice Address - Fax:928-776-6125
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY186363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical