Provider Demographics
NPI:1962636845
Name:LAR, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LAR
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 1:17900 N PORTER RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-4228
Mailing Address - Country:US
Mailing Address - Phone:520-233-2500
Mailing Address - Fax:520-233-2688
Practice Address - Street 1:17900 N PORTER RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4228
Practice Address - Country:US
Practice Address - Phone:520-233-2500
Practice Address - Fax:520-233-2688
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253530-1208000000X
TXP4073208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY40836975OtherUSMLE
TX8DK698OtherBCBS
TX303196501Medicaid
CT677857OtherAMERICAN BOARD OF PEDIATRICS
NY03161066Medicaid
NY03161066Medicaid
NY40836975OtherUSMLE