| Doctor Name: | BRAD RODNEY LARSEN |
| NPI Number: | 1063430890 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.A. |
| License Number: | PA0272 |
| Business Practice Address: | 2950 N Church St Ste 200 Layton, UT - 840406504 |
| Business Phone Number: | 8017717700 |
| Business Fax Number: | 8015462422 |
| Mailing Address: | 127 S. 500 E., Suite 600 SALT LAKE CITY |
| State: | UT |
| Postal Code: | 841021971 |
| Phone Number: | 8015876336 |
| Fax Number: | 8017158228 |
| NPI Enumeration Date: | 07/18/2006 |
| NPI Last Update Date: | 08/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA0272 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |