Individual
DR. MICHELLE LYN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
51743
MN
207VX0000X
Obstetrics Physician
Primary
53219
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235618
—
AZ
01
—
53219
AZ MEDICAL LICENCSE
AZ
Enumeration date
06/04/2007
Last updated
09/13/2021
Update your record
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