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General NPI Number Information
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NPI Number | 1285405514
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Entity Type | Individual
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Provider Name | JOSEPH ROBERT LACH III NP
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Gender | Male
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 107 E OAK AVE STE 201
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-1819
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Country | US
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Telephone | 928-913-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 2523 S QUITMAN ST
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City | DENVER
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State | CO
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Zip | 80219-5721
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Country | US
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Telephone | 330-309-9289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 301003
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License Number State | AZ
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