Provider Demographics
NPI:1558180208
Name:LARSEN, DARREN THOMAS (CSFA)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:THOMAS
Last Name:LARSEN
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 MCKEEVER RD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-2339
Mailing Address - Country:US
Mailing Address - Phone:979-549-1217
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 10084
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75711-0084
Practice Address - Country:US
Practice Address - Phone:979-549-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty