Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | A54791 | CA |
NPI | 1043299399 |
---|---|
Provider Name | Dr. Bruce R Lasker |
First Address | San Diego, CA 92117-5459 |
Second Address | San Diego, CA 92117-5404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2006 |
Last Update Date | 01/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G547910 | (05) | CA |
A93321 | (02) | CA |