Brad David Larsen, PA-C

NPI #1144700782

Provider Information

NPI Number: 1144700782
Entity Type: Individual
Name: Brad David Larsen, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant - Medical
Credential: PA-C
Enumeration Date: Aug 14, 2018
Last Updated: Aug 17, 2022

Practice Location

Address: 31ST MEDICAL GROUP
Address 2: UNIT 6180
City: Apo
State: AE
ZIP Code: 09604
Phone: (314) 632-5105

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X
Student in an Organized Health Care Education/Training Program	390200000X
Physician Assistant - Medical — Medical	363AM0700X	Primary

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