Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 01077347A | IN |
NPI | 1023402054 |
---|---|
Provider Name | Matthew Joesph Lash |
First Address | Jacksonville, NC 28547-2538 |
Second Address | Jacksonville, NC 28547-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 28/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD0000 | (02) | CA |