Basic Information
| Provider Information | |||||||||
| NPI: | 1477513562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARUE | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPAS,APA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5231 N LONE DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863144339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009491005 | ||||||||
| FaxNumber: | 9287766125 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 HWY 89 NORTH | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009491005 | ||||||||
| FaxNumber: | 9287766125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 186 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.