Healthcare Provider Details

I. General information

NPI: 1629853312
Provider Name (Legal Business Name): LASH ORTHOSPINE AND SPORTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 ROSS CLARK CIR STE 2
DOTHAN AL
36301-9917
US

IV. Provider business mailing address

2800 ROSS CLARK CIR STE 2
DOTHAN AL
36301-9917
US

V. Phone/Fax

Practice location:
  • Phone: 480-262-5758
  • Fax:
Mailing address:
  • Phone: 334-239-0063
  • Fax: 334-239-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DUSTIN LASH
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 480-262-5758