Provider Demographics
NPI:1487334843
Name:JONATHAN LARSON MD PC
Entity type:Organization
Organization Name:JONATHAN LARSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-484-9517
Mailing Address - Street 1:2505 ANTHEM VILLAGE DRIVE SUITE F #162
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:949-484-9517
Mailing Address - Fax:949-569-1295
Practice Address - Street 1:10 N HIGH ST STE 222
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3497
Practice Address - Country:US
Practice Address - Phone:949-484-9517
Practice Address - Fax:949-569-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty