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General NPI Number Information
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NPI Number | 1487759809
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Entity Type | Organization
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Legal Business Name | R. R.LASTOMIRSKY, M.D., P.A.
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 740 THE RIALTO
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City | VENICE
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State | FL
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Zip | 34285-3524
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Country | US
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Telephone | 941-484-8414
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Fax | 941-488-7586
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Provider Business Mailing Address
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Address Line | 740 THE RIALTO P. O. BOX 1803
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City | VENICE
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State | FL
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Zip | 34285-3524
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Country | US
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Telephone | 941-484-8414
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Fax | 941-488-7586
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. ROBERT RAYMOND LASTOMIRSKY
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Credential | M.D.
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Telephone | 941-484-8414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0032829
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License Number State | FL
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