Individual
ISRAEL DANIEL LARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13013 FULLER AVE STE A, GRANDVIEW, MO 64030-2687
(915) 867-0499
Mailing address
1501 E WHITTON AVE APT 302, PHOENIX, AZ 85014-5180
(915) 867-0499
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/30/2024
Last updated
12/02/2024
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