Individual
JACOB LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
775 POLE LINE RD W STE 103, TWIN FALLS, ID 83301-5819
(480) 620-2084
Mailing address
680 SUNRISE BLVD, TWIN FALLS, ID 83301-7060
(480) 620-2084
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
ID
Other
Enumeration date
09/23/2015
Last updated
09/23/2015
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