Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 60249293 | WA |
N | 208D00000X | General Practice Physician | 48844-020 | WI |
NPI | 1003887720 |
---|---|
Provider Name | Dr. Brooks Thomas Laselle |
First Address | Liberty Lake, WA 99019-7507 |
Second Address | Spokane, WA 99204-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 20/06/2013 |