Individual
HANS TYLER LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
775 POLE LINE RD W, TWIN FALLS, ID 83301-5814
(208) 814-8200
Mailing address
775 POLE LINE RD W, TWIN FALLS, ID 83301-5814
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1249
ID
Other
Enumeration date
05/07/2015
Last updated
11/30/2021
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