Bryan R. Larsen, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

174573-1205 Issued in UT

Practice address

630 E 1400 N
Suite 100B
Logan, UT 84341-2534

Phone

(435) 787-0270

Fax

(435) 787-0262

NPI assigned

May 4, 2006

Last updated

Sep 27, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northern Utah Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Logan, UT
  • NPI 1902875669
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1972561165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 E 1400 N",
            "address_2": "SUITE 100B",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412534",
            "telephone_number": "435-787-0270",
            "fax_number": "435-787-0262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E 1400 N",
            "address_2": "SUITE 100B",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412534",
            "telephone_number": "435-787-0270",
            "fax_number": "435-787-0262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "BRYAN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "UT",
            "license": "174573-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003794300",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "brian.larsen@direct.imail.org",
            "affiliation": "N",
            "address_1": "630 E 1400 N",
            "address_2": "Suite 100B",
            "city": "Logan",
            "state": "UT",
            "country_code": "US",
            "postal_code": "843412534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alisse V Larkin, RDN
• Amy Astle Larkin
• Joseph Eugene Larkin
• Larry T Hogge DDS PC
• Brian Therald Larsen, PT
• Jeffery Blythe Larsen, PH.D., CCC-A
• Makynzie Larsen, AU.D.
• Ryan H Larsen, MD
• Steven Scott Larsen, D.D.S. M.S.
• Brad J Larson, MD

• Gastroenterology Physician in Logan, UT
• Providers in Logan, UT by specialty
• Gastroenterology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.