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Individual

SHANE R LARSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1551 E TANGERINE RD, ORO VALLEY, AZ 85755-6213
(520) 901-3500
Mailing address
274 N MAIN ST, LOGAN, UT 84321-3915
(435) 753-1600
(435) 753-9521

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
342616-1205
UT
207L00000X
Anesthesiology Physician
Primary
77353
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
870550181001
UT
Enumeration date
05/11/2006
Last updated
06/16/2025
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