Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | AO5603724206896 | OH |
N | 208600000X | Surgeon | AO5603724206896 | OH |
Y | 2086S0105X | Surgery of the Hand | 58871 | AZ |
NPI | 1891040440 |
---|---|
Provider Name | Michael Thorpe Larsen |
First Address | Phoenix, AZ 85004-1254 |
Second Address | Phoenix, AZ 85004-1254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 18/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
553192 | (05) | AZ |