Healthcare Provider Details

I. General information

NPI: 1639265838
Provider Name (Legal Business Name): DONALD LASSELLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 DIVISION ST
GRANDVIEW WA
98930-1357
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-882-4260
  • Fax: 509-882-6088
Mailing address:
  • Phone: 509-865-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00035782
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: