Basic Information
| Provider Information | |||||||||
| NPI: | 1306824149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARSEN | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7150 W SUNSET RD | ||||||||
| Address2: | SUITE 201A | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891131981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023854342 | ||||||||
| FaxNumber: | 7023854346 | ||||||||
| Practice Location | |||||||||
| Address1: | 9053 S PECOS RD | ||||||||
| Address2: | SUITE 2900 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890747177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027358000 | ||||||||
| FaxNumber: | 7027354795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 1668241205 | UT | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 6317 | NV | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 002019159 | 05 | NV | MEDICAID | V33978 | 01 | NV | MEDICARE ID | OTHER |