Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 19358 | NE |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 50163 | AZ |
NPI | 1164719779 |
---|---|
Provider Name | Larry Parsons |
First Address | Prescott, AZ 86304-0880 |
Second Address | Prescott, AZ 86301-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2011 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013361 | (05) | AZ |
50163 | MEDICAL LICENSE (01) | AZ |
FP2428161 | US DEPT OF JUSTICE - DRUG ENFORCEMENT ADMIN (01) |