BRAD DAVID LARSEN (NPI# 1144700782) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144700782 |
| Entity Type | Individual |
| Full Name | BRAD DAVID LARSEN |
| Other Name | BRADLEY DAVID LARSEN |
| Credential | PA-C |
| Practice Address |
655 7th St Bldg 700-a78 Robins Afb GA 31098 |
| Mailing Address |
104 Fechet Dr Biloxi MS 39531-2662 |
| Practice Telephone | 4783278040 |
| Mailing Telephone | 8135499177 |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2019-09-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 1161415 | GA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 500 Fisher St, Biloxi, MS 395342502 | 2283762273 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063430890 | Brad Rodney Larsen | Physician Assistant | 2950 N Church St, Ste 200, Layton, UT 84040-6504 | 2006-07-18 |
| Street Address |
655 7TH ST BLDG 700-A78 |
| City | ROBINS AFB |
| State | GA |
| Zip Code | 31098 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225005291 | Jon Morris Johnson | Family Medicine | 655 7th St Bldg 700-a78, Robins Afb, GA 31098-2227 | 2006-03-08 |
| 1194245316 | Christina Kathleen Loyke | Family Medicine | 655 7th St Bldg 700-a78, Robins Afb, GA 31098-2227 | 2017-06-20 |
| 1245633536 | Melissa Cable | Social Worker | 655 7th St Bldg 700-a78, Robins Afb, GA 31098-2227 | 2014-10-01 |
| 1437551900 | Kimberly Marketto | Social Worker | 655 7th St Bldg 700-a78, Robins Afb, GA 31098-2227 | 2014-09-16 |
| 1629332564 | Jeffrey Meade | Preventive Medicine | 655 7th St Bldg 700-a78, Robins Afb, GA 31098 | 2012-06-26 |
| 1710254453 | Laureal Janeice Anderson | Nurse Practitioner | 655 7th St Bldg 700-a78, Robins Afb, GA 31098 | 2011-11-23 |
| 1154560902 | Sean Indiano Moore | Preventive Medicine | 655 7th St Bldg 700-a78, Robins Afb, GA 31098-2227 | 2009-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043679426 | Lori Demello | Behavioral Analyst | 477 Holly Drive, Warner Robins, GA 31098 | 2016-02-15 |
| 1760885057 | John A Kauderman Jr. | Optometrist | 655 South 7th St Bldg 700/700a, Robins Afb, GA 31098 | 2014-10-01 |
| 1255757183 | Damon Jamel Murphy | Psychologist | 655 South 7th St Bldg 700, 78 Mdg/sgpo, Robins Afb, GA 31098 | 2014-03-17 |
| 1548697485 | John Dye Jr. | Military Health Care Provider | 655 Seventh St., Robins Afb, GA 31098 | 2013-10-10 |
| 1881028009 | Michael Adam Lang | General Practice | Building 700a, Robins Afb, GA 31098 | 2013-08-23 |
| 1902243876 | Victor D Parker IIi | Military Health Care Provider | 78th Medical Group Sghc, 655 Seventh Street, Robins Afb, GA 31098 | 2013-05-31 |
| 1851646830 | David Alan Lunsford Jr. | Physical Therapist | 655 South 7th St Bldg 700/700-a, 78 Mdg/sgoy, Robins Afb, GA 31098 | 2012-07-17 |
| 1972880979 | Leighcraft A Shakes | Pharmacist | 655 7th St Bldg 700a7878, Robins Afb, GA 31098 | 2011-11-04 |
| 1154625101 | Carolina Anna Perez | Counselor | 655 Seventh Street, Robins Afb, Warner Robines, GA 31098 | 2011-01-05 |
| 1811128754 | Shawn Christopher Moore | Military Health Care Provider | 655th 7th Street, Robins Afb, GA 31098 | 2009-07-27 |
| Find all providers in zip 31098 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528168069 | Jeffrey Daniel Kiser | Family Medicine | 655 7th St Bldg 70078, Robins Afb, GA 31098-2227 | 2006-09-24 |
| 1225005291 | Jon Morris Johnson | Family Medicine | 655 7th St Bldg 700-a78, Robins Afb, GA 31098-2227 | 2006-03-08 |
| 1467442681 | Melinda D Screws | Family Medicine | 655 South 7th St, Bldg 700/700-a, 78 Mdg/sgh, Robins Afb, GA 31098 | 2005-10-27 |
| 1407845761 | Jeffrey Freeland | Family Medicine | 78 Mdos Robins Afb Medical Clinic, Robins Afb, GA 31098 | 2005-10-19 |
| 1194245316 | Christina Kathleen Loyke | Family Medicine | 655 7th St Bldg 700-a78, Robins Afb, GA 31098-2227 | 2017-06-20 |
| 1437425915 | Sean Trevar Nelson | Family Medicine | 655 7th St Bldg 700700a, 78 Mdg/sgof, Robins Afb, GA 31098-2227 | 2012-03-28 |
| 1205148392 | Anna Marie Maruska | Family Medicine | 655 South 7th Street Bldg 700/700a, 78mdg/sgof, Robins Afb, GA 31098 | 2010-07-06 |
| 1467686493 | Daniel Troy Truscott | Family Medicine | 655 7th St Bldg 700700-a, 78 Mdg/sgohf, Robins Afb, GA 31098-2227 | 2009-05-05 |
| 1326118555 | David Merrill Oldham | Family Medicine | 655 South 7th Street Bldg 700/700-a, 78 Mdg/sgp, Robins Afb, GA 31098 | 2006-11-08 |
| 1598844482 | June Cook | Family Medicine | 655 7th St Bldg 700700a, 78 Mdg/sgp, Robins Afb, GA 31098-2227 | 2006-11-03 |
| Find all providers in ROBINS AFB | ||||
| City | ROBINS AFB |
| Zip Code | 31098 |
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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.