1124273032 NPI number — CENTER FOR COLON AND RECTAL DISEASES PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124273032 NPI number — CENTER FOR COLON AND RECTAL DISEASES PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR COLON AND RECTAL DISEASES PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DAVID M LARSON MD
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124273032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 S DOBSON ROAD
Provider Second Line Business Mailing Address:
SUITE 313
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85202-4713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-964-0707
Provider Business Mailing Address Fax Number:
480-464-0588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 S DOBSON RD
Provider Second Line Business Practice Location Address:
SUITE 313
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85202-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-964-0707
Provider Business Practice Location Address Fax Number:
480-464-0588
Provider Enumeration Date:
11/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-964-0707

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  12943 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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