Provider Demographics
NPI:1689637019
Name:LARSEN, DONALD BRENT (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:BRENT
Last Name:LARSEN
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:PO BOX 2710
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-2710
Mailing Address - Country:US
Mailing Address - Phone:480-882-6359
Mailing Address - Fax:480-882-4389
Practice Address - Street 1:7400 E OSBORN RD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6432
Practice Address - Country:US
Practice Address - Phone:480-882-6359
Practice Address - Fax:480-882-4389
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11082146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE59828Medicare UPIN
AZZWMBFG19Medicare PIN