Individual
KENNETH B LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1600 S 20TH AVE, SAFFORD, AZ 85546-4011
(928) 348-4021
Mailing address
2250 W 16TH ST, SAFFORD, AZ 85546-4081
(928) 428-1947
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1090
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184841
—
AZ
Enumeration date
12/07/2006
Last updated
02/21/2017
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