Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Brett C Larsen, PA

Individual provider Physician Assistant · NPI 1639367337

Brett C Larsen, PA is a Physician Assistant in Roosevelt, Utah. Qualified in 2007, 19 years ago. Practices with Evanston Clinic Corp, a 25-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
19
Licensed in
UT
In the registry since
2007
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

210 W 300 N 75-3
Roosevelt, UT 84066-2336
Phone: (435) 722-3971
Fax: (435) 722-9291
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 6704805-1206 (UT)

Record details

NPI number1639367337
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 9, 2007
Last updated in NPPESMarch 13, 2008

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Evanston Clinic Corp — 25 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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