Individual
BRETT C LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
210 W 300 N, 75-3, ROOSEVELT, UT 84066-2336
(435) 722-3971
(435) 722-9291
Mailing address
210 W 300 N, 75-3, ROOSEVELT, UT 84066-2336
(435) 722-3971
(435) 722-9291
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6704805-1206
UT
Other
Enumeration date
10/09/2007
Last updated
03/13/2008
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