Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0216X | Pediatric Rheumatologist | 2001004977 | MO |
Y | 2080P0216X | Pediatric Rheumatologist | MD161685 | OR |
NPI | 1982625778 |
---|---|
Provider Name | Andrew S Lasky |
First Address | Portland, OR 97227-2005 |
Second Address | Portland, OR 97227-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205241201 | (05) | MO |
G36994 | (02) | MO |