Individual
STEPHEN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13555 W MCDOWELL RD, 302, GOODYEAR, AZ 85395-2624
(623) 512-4390
(623) 512-4391
Mailing address
17560 N 75TH AVE, SUITE 440, GLENDALE, AZ 85308-5983
(623) 512-4390
(623) 512-4139
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
125-056789
IL
208800000X
Urology Physician
Primary
50775
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053337
—
AZ
Enumeration date
06/25/2009
Last updated
01/18/2017
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