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Individual

EVERETT WAYNE LARSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1786 N MAIN ST, CENTERVILLE, UT 84014-1133
(801) 599-5905
Mailing address
1786 N MAIN ST, CENTERVILLE, UT 84014-1133
(801) 599-5905

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
148317
MT
207L00000X
Anesthesiology Physician
Primary
187423-1205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
11084
UT
Enumeration date
06/29/2006
Last updated
04/23/2026
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