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General NPI Number Information
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NPI Number | 1124194220
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Entity Type | Organization
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Legal Business Name | BLUEFIELD MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 510 CHERRY ST SUITE 102
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City | BLUEFIELD
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State | WV
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Zip | 24701-3338
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Country | US
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Telephone | 304-327-2568
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Fax | 304-324-0800
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Provider Business Mailing Address
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Address Line | PO BOX 1519
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City | BLUEFIELD
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State | WV
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Zip | 24701-1519
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Country | US
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Telephone | 304-327-2568
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Fax | 304-324-0800
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BRUCE LARENCE LASKER
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Credential | M.D.
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Telephone | 304-327-2568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | WV10952
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License Number State | WV
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