Individual
DR. BRUCE D LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2850 N 2000 W, FARR WEST, UT 84404-9219
(801) 377-5757
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49625291205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
942854058001
—
UT
Enumeration date
10/18/2006
Last updated
06/14/2019
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