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1679168223
ALEXANDER RONALD LARSON
BOISE, ID
NPI
1679168223
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: ID PA-2128)
Enumeration Date
2021-03-05
Last Update Date
2021-10-11
Business Address
ALEXANDER RONALD LARSON
1907 S BROADWAY AVE STE 101
BOISE, ID 83706-4229
Phone number: 208-345-1222
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Mailing Address
ALEXANDER RONALD LARSON
PO BOX 191050
BOISE, ID 83719-1050
Phone number: 208-985-1399
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