Healthcare Provider Details

I. General information

NPI: 1902880982
Provider Name (Legal Business Name): OLGA E LASATER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE SUITE 300
MEMPHIS TN
38104-6638
US

IV. Provider business mailing address

1211 UNION AVE SUITE 300
MEMPHIS TN
38104-6638
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-7551
  • Fax: 901-725-9721
Mailing address:
  • Phone: 901-725-7551
  • Fax: 901-725-9721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number017152
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: