BRAD RODNEY LARSEN (NPI# 1063430890) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063430890 |
| Entity Type | Individual |
| Full Name | BRAD RODNEY LARSEN |
| Credential | P.A. |
| Practice Address |
2950 N Church St Ste 200 Layton UT 84040-6504 |
| Mailing Address |
127 S. 500 E. Suite 600 Salt Lake City UT 84102-1971 |
| Practice Telephone | 8017717700 |
| Practice Fax Number | 8015462422 |
| Mailing Telephone | 8015876336 |
| Mailing Fax Number | 8017158228 |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2015-08-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5166627-1206 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA0272 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144700782 | Brad David Larsen | Family Medicine | 655 7th St Bldg 700-a78, Robins Afb, GA 31098 | 2018-08-14 |
| Street Address |
2950 N CHURCH ST STE 200 |
| City | LAYTON |
| State | UT |
| Zip Code | 84040-6504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861850406 | Susan Christine Ashdown | Physical Therapist | 2950 N Church St, Ste. 102, Layton, UT 84040-6504 | 2016-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902410947 | Creek Dental Group Meadowbrook LLC | Dentist | 1148 E Ut-193, Layton, UT 84040 | 2020-09-08 |
| 1902417629 | Christopher Luis Perez | Behavior Technician | 2940 Church Street, Suite 303, Layton, Davis, UT 84040 | 2020-08-14 |
| 1851939011 | Shaunell Young | Counselor | 2264 N 2650 E, 2264 N 2650 E, Layton, UT 84040 | 2019-12-18 |
| 1568929875 | Cassie Marie Decker | Behavior Technician | 2935 N 935 E, Layton, UT 84040 | 2019-02-22 |
| 1174035257 | Emily Reed | Behavior Technician | 935 E 2985 N, Layton, UT 84040 | 2017-10-30 |
| 1679008122 | Christopher Valdez | Behavior Technician | 935 East 2985 North, Layton, UT 84040 | 2017-04-21 |
| 1194175463 | Halie Checketts | Behavior Technician | 935 E 2985 S, Layton, UT 84040 | 2016-06-17 |
| 1609231125 | Katherine Pike Macias | Speech-Language Pathologist | 201 W Latyon Parkway, Layton, UT 84040 | 2015-12-28 |
| 1891164752 | Katherine Dean Turek | Social Worker | 476 West Heritage Park Blvd, Suite 220, Layton, UT 84040 | 2015-09-22 |
| 1790152189 | Alma Discuillo | Behavior Technician | 2490 N Church St, Layton, UT 84040 | 2015-09-01 |
| Find all providers in zip 84040 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871945618 | Shaun Mickelsen | Physician Assistant | 2121 N 1700 W, Layton, UT 84041-8803 | 2016-07-05 |
| 1366819575 | Val Duane Warner | Physician Assistant | 2121 N 1700 W, Layton, UT 84041-8803 | 2015-08-24 |
| 1417267956 | Kurt R Umbrell | Physician Assistant | 2132 N 1700 W, Suite 200, Layton, UT 84041-7057 | 2010-10-18 |
| 1902967219 | Roderick D Maxwell | Physician Assistant | 2084 N 1700 W, Suite A, Layton, UT 84041 | 2006-12-12 |
| 1831175272 | Robert Bunnell | Physician Assistant | 2084 N 1700 W, Suite A, Layton, UT 84041 | 2005-12-19 |
| 1295710960 | Ronald Scott Bingham | Physician Assistant | 1580 W Antelope Dr, Suite 100, Layton, UT 84041-1160 | 2005-12-14 |
| 1467440701 | Mont C Robins | Physician Assistant | 124 S Fairfield Rd, Layton, UT 84041-7105 | 2005-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134748080 | Shannon Dhungel | Physician Assistant | 82 S 1100 E Ste 402, Salt Lake City, UT 84102-1892 | 2020-04-10 |
| 1437702875 | Jennica Marie Van Blerkom | Physician Assistant | 4755 S Wallace Ln, Holladay, UT 84117-6458 | 2019-07-23 |
| 1124599873 | Tcfh Lc | Physician Assistant | 9777 N 5520 W, Highland, UT 84003-9130 | 2018-12-06 |
| 1528533825 | Ryan Mclean Walsh | Physician Assistant | 1454 University Vlg, Salt Lake City, UT 84108-3518 | 2018-10-12 |
| 1033627351 | Linda Richards Lewis | Physician Assistant | 30 N. 1900 E, Som 5r218, Salt Lake City, UT 84132-0002 | 2018-01-22 |
| 1215446919 | Richard L Mittan | Physician Assistant | 65 E 6850 S, Midvale, UT 84047-1215 | 2017-09-25 |
| 1710416649 | Brian Adams | Physician Assistant | 1308 E 900 S # C, St George, UT 84790-8520 | 2017-06-05 |
| 1972036242 | Jace Meng | Physician Assistant | 30 N 1900 E Rm 5r218, Salt Lake City, UT 84132-0002 | 2017-04-04 |
| 1396289799 | Jefferson M Allen | Physician Assistant | 356 W 840 S, Orem, UT 84058-6778 | 2016-12-05 |
| 1609324151 | Colby Bliss | Physician Assistant | 826 N Paiute Way, Richfield, UT 84701-1849 | 2016-09-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.