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General NPI Number Information
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NPI Number | 1629853312
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Entity Type | Organization
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Legal Business Name | LASH ORTHOSPINE AND SPORTS LLC
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 2800 ROSS CLARK CIR STE 2
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City | DOTHAN
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State | AL
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Zip | 36301-9917
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Country | US
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Telephone | 480-262-5758
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 ROSS CLARK CIR STE 2
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City | DOTHAN
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State | AL
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Zip | 36301-9917
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Country | US
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Telephone | 334-239-0063
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Fax | 334-239-4493
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. DUSTIN LASH
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Credential | DO
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Telephone | 480-262-5758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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