Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 63422 | AZ |
NPI | 1013005321 |
---|---|
Provider Name | Paul S Larson |
First Address | Tucson, AZ 85724-5070 |
Second Address | Tucson, AZ 85724-0350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 25/07/2021 |