Provider Demographics
NPI:1770599623
Name:LARSON, DANIEL KURTIS (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KURTIS
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7757 N. DEERFIELD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7747
Mailing Address - Country:US
Mailing Address - Phone:928-728-5626
Mailing Address - Fax:509-835-4058
Practice Address - Street 1:7757 N. DEERFIELD
Practice Address - Street 2:
Practice Address - City:PRESSCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7747
Practice Address - Country:US
Practice Address - Phone:928-728-5626
Practice Address - Fax:509-835-4058
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA23114207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1007012Medicaid
000355521Medicare PIN
WA1007012Medicaid