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NPI Code Detail

MEDICARE: JOHN LACSON

MEDICARE: JOHN LACSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramOT18912PA
2207Q00000XFamily Medicine Physician009179AZ

General Provider Information

NPI Number : 1104313634
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN LACSON
Provider Business Mailing Address
First Line : PO BOX 33269
Second Line :
City : PHOENIX
State : AZ
Zip : 85067-3269
Country : US
Telephone Number : 602-406-4786
Fax Number : 916-636-4358
Provider Business Practice Location Address
First Line : 2927 N 7TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4102
Country : US
Telephone Number : 602-406-3153
Fax Number : 602-406-7176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2018
Last Update Date : 05/13/2026

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Directions to “ JOHN LACSON ” Practice Location

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