Individual
MR. BRANDON LEON LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1301 E 17TH ST, IDAHO FALLS, ID 83404-6273
(208) 991-4296
(208) 656-2846
Mailing address
891 TIE BREAKER DR, AMMON, ID 83406-4554
(208) 569-8676
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-1985
ID
Other
Enumeration date
12/13/2020
Last updated
11/19/2024
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