Provider Demographics
NPI:1336407774
Name:LARSON, ANDREW ROBERT (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ROBERT
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4738
Mailing Address - Country:US
Mailing Address - Phone:734-262-2430
Mailing Address - Fax:
Practice Address - Street 1:801 E HILLTOP AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4738
Practice Address - Country:US
Practice Address - Phone:734-262-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine