Individual
JAY C LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
5750 W THUNDERBIRD RD STE G700, GLENDALE, AZ 85306
(602) 938-3600
Mailing address
5750 W THUNDERBIRD RD STE G700, GLENDALE, AZ 85306-4673
(602) 938-3600
(602) 938-0400
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
0729
AZ
213E00000X
Podiatrist
5901002297
MI
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0729
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
618036
—
AZ
Enumeration date
06/25/2008
Last updated
07/20/2021
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