Individual
MR. TATE KENNEDY LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1755 N 200 E, LOGAN, UT 84341-1915
(801) 499-6300
Mailing address
971 S 800 W, BRIGHAM CITY, UT 84302-3042
(801) 499-6300
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
UT
Other
Enumeration date
01/10/2019
Last updated
01/10/2019
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